Abstract 523: Ultrasound Assisted Thrombolysis Versus Catheter Directed Thrombolysis: A Meta-Analysis

Abstract

Introduction: Deep venous thrombosis (DVT) and pulmonary embolism (PE) have many methods of treatment including anti-coagulation, thrombectomy and thrombolysis. Thrombolysis can be achieved via systemic or local thrombolytic agents, with standard local thrombolysis achieved via catheter insertion in proximity to the thrombus and delivery of thrombolytic agents. Ultrasound-assisted catheter thrombolysis (UAT) is a relatively newer form of thrombolysis which utilizes ultrasonic energy, along with local thrombolytics to help in thrombus breakdown. The objective of our meta-analysis is to compare UAT and catheter directed thrombolysis (CDT) for treatment of DVT and PE. Methods: PubMed database was searched through January 2017. Three studies (n=156) comparing UAT (n=99) and CDT (n=57) for thrombolysis were included. End points were > 50% thrombus lysis, bleeding (moderate and severe), and mortality on short term follow up (<1 year). The relative risk (RR) or mean difference (MD) with 95% confidence interval (CI) was computed and p<0.05 was considered as a level of significance. Results: Thrombolysis success rate was similar with UAT and CDT (RR 1.06, CI 0.89-1.27, p=0.49). Moderate and severe bleeding events were similar with both groups (RR 0.71, CI 0.27-1.87, p=0.49). Mortality on short term follow up was significantly lower in UAT as compared to CDT (RR 0.47, CI 0.23-0.95, p=0.04). Conclusions: The results of our meta-analysis demonstrated no difference in thrombolysis success rate or bleeding events when using UAT Vs CDT, however short term mortality was significantly lower with UAT. Further controlled trials with larger sample sizes are required to assess the possible benefit of using ultrasonic energy for venous thrombolysis.