Coagulation-monitored, dose-adjusted catheter-directed thrombolysis or pharmaco-mechanical thrombus removal in deep vein thrombosis.

Abstract

Background: Pharmaco-mechanical thrombectomy (PMT) and catheter-directed thrombolysis (CDT) are therapeutic options for selected patients with acute deep vein thrombosis (DVT) to prevent post-thrombotic syndrome (PTS). Patients and methods: We aimed to describe the clinical characteristics and outcomes of 159 patients with symptomatic iliofemoral DVT undergoing PMT alone, CDT alone, or CDT followed by PMT (bail-out) in the Swiss Venous Stent Registry. The primary outcome was the incidence of peri-interventional major and minor bleeding complications (ISTH criteria). Secondary outcomes included the incidence of PTS and stent patency after 3 years. Results: Mean age was 49±20 years and 58% were women. DVT involved the iliac veins in 99% of patients, whereas 53% had an underlying iliac vein compression. PMT alone was used in 40 patients, CDT alone in 77, and 42 received initial CDT followed by bail-out PMT due to insufficient thrombus clearance. Single-session PMT was the preferred approach in patients with iliac vein compression, patent popliteal vein, and absence of IVC thrombus. Patients treated with PMT alone received a lower r-tPA dose (median 10 mg, IQR 10-10) vs. those treated with CDT (20 mg, IQR 10-30). The rate of peri-interventional major bleeding was 0%, 1%, and 2%, whereas that of minor bleeding was 0%, 1%, and 12%, respectively, all occurring during CDT. After 3 years, PTS occurred in 6%, 9%, and 7% of patients, respectively. The primary stent patency rate was 95%, 88%, and 83%, respectively. Conclusions: The use of PMT and CDT for iliofemoral DVT was overall safe and resulted in high long-term patency and treatment success. Given the less severe presentation of DVT, single-session PMT appeared to be characterized by numerically better primary patency and lower perioperative bleeding event rates than CDT.

• Authors: Julian Kleine Wortmann, Stefano Barco, Riccardo M Fumagalli, Davide Voci, Ulrike Hügel, Rahel Cola, David Spirk, Nils Kucher, Tim Sebastian
• Journal: VASA. Zeitschrift fur Gefasskrankheiten (Vasa) Vol. 52 Issue 6 Pg. 416-422 (Nov 2023) ISSN: 0301-1526 [Print] Switzerland
• PMID: 37847240 (Publication Type: Journal Article)

Chemical References

• Fibrinolytic Agents

Topics

• Humans
• Female
• Adult
• Middle Aged
• Aged
• Male
• Thrombolytic Therapy (adverse effects)
• Thrombectomy (adverse effects, methods)
• Venous Thrombosis (diagnostic imaging, therapy, complications)
• Postthrombotic Syndrome (etiology, prevention & control)
• Catheters (adverse effects)
• Hemorrhage (chemically induced)
• Treatment Outcome
• Iliac Vein (diagnostic imaging, surgery)
• Retrospective Studies
• Fibrinolytic Agents (therapeutic use)