Catheter directed thrombolysis for deep vein thrombosis in 2022: Rationale, evidence base and future directions. (1st September 2022)

• Record Type: Journal Article
• Authors: Khalid, Muhammad Umar; Singh, Maninder; Lakhter, Vladimir; Bashir, Riyaz
• Is Part Of: International journal of cardiology. Volume 362(2022)
• Page Start: 168
• Page End: 173
• Publication Date: 2022-09-01
• Subjects: Acute proximal DVT -- Intracranial hemorrhage -- Catheter-directed thrombolysis; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2022.04.081
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Introduction: Catheter directed thrombolysis (CDT) has evolved as a treatment modality for patients diagnosed with proximal and caval deep vein thrombosis (DVT) and has shown to be superior in certain subset of patient population despite conflicting evidence as seen in the large 4 randomized controlled trials. Rationale for CDT in acute DVT patients: DVT adversely affects the quality of life and adds significantly to the treatment and hospitalization costs. CDT and pharmaco-mechanical catheter directed thrombolysis (PCDT) has been shown to accelerate symptom resolution, decrease symptom severity and decrease recurrence rates with successful procedures in certain patients. Randomized clinical trials (RCTs): Four RCTs have evaluated the use of CDT and PCDT in acute proximal DVT patients suggesting clinical benefit compared to anticoagulation alone. These trials suggested using CDT for proximal DVT patients with a lower bleeding risk as CDT may decrease PTS. Successful CDT treatment showed improvement in moderate to severe symptoms of post thrombotic syndrome (PTS). However, these studies have limitations including the use of non-standard techniques, different equipment and different endpoints. Future directions and conclusion: Our goal is to highlight the factors which can potentially improve CDT outcomes in proximal DVT patients. Based on studies, patients with proximal DVT and a low bleeding risk may benefit from early CDT by decreased symptom severity of PTS, however, improvement in procedural technique, equipment and procedural success rates is necessary. With appropriate patient selection, and objective endpoints, we can further establish the benefit of CDT and PCDT in acute DVT patients. Highlights: Catheter Directed Thrombolysis for acute proximal deep vein thrombosis (DVT) and caval DVT has increasing utilized in the recent years and is associated with accelerated symptom resolution and improved quality of life. Four randomized clinical trials have showed conflicting evidence and further studies are needed with improved patient selection to better understand the benefit of catheter directed thrombolysis over conventional therapy. Successful catheter directed thrombolysis is associated with lower rates of moderate to severe post thrombotic syndrome and improved quality of life. Adoption of novel devices, improvement in procedural techniques and appropriate selection of patients can all contribute to the improving safety of catheter directed thrombolysis and decreased rate of complications such as intracranial hemorrhage.