Catheter-directed Thrombolysis, Thrombectomy And Systematic Anticoagulant In Treating Acute Iliofemoral Deep Vein Thrombosis About Clinical Efficacy:A Meta-analysis

ObjectiveTo compare the clinical efficacy of catheter-directed thrombolysis, thrombectomy and systematic anticoagulant in treating acute iliofemoral deep vein thrombosis of lower limb using Meta-analysis method.MethodsRetrieved randomized controlled trial (RCT)comparing catheter-directed thrombolysis, thrombectomy and systematic anticoagulant clinical effects published from January 1984 to January 2014. A Meta-analysis was conducted to estimate early vein patency, post-thrombotic syndrome, venous reflux rate, venous obstruction rate.ResultsTen RCTs were included in this analysis, including 626 patients. The early vein patency rate was higher in the CDT group and the difference was statistically significant(OR=4.61,95%CI 1.93-10.98, p=0.0006), there is no statistically difference between ST and SA group(OR=2.54,95%CI 0.49-13.24, p=0.27).The post-thrombotic syndrome rate was less both in the CDT group(OR=0.18,95% CI 0.07-0.43, p=0.0002)and ST group(OR=0.50,95%CI 0.28-0.87,p=0.01),the difference was statistically significant. The difference of the venous reflux rate was not statistically significant in both two groups.The venous obstruction rate was less in the CDT group(OR=0.19,95%CI 0.11～0.34,p<0.01)and the difference was statistically significant, while the difference was not statistically significant beween ST and SA group(OR=1.53,95%CI 0.72-3.26, p=0.27).ConclusionFor acute iliofemoral deep vein thrombosis, short-term outcomes of catheter-directed thrombolysis was better than anticoagulant therapy, but thrombolysis brought more bleeding. In long-term outcomes, the post-thrombotic syndrome rate wa less both in the thrombolysis group and the thrombectomy.Catheter-directed thrombolysis also can diminish the vein obstruction rate.