Role Of Catheter-directed Thrombolysis Research Articles

Clot Limiting vs. Clot Busting: The Role of Catheter-directed Thrombolysis in Treating Intermediate- to High-risk Pulmonary Embolism

Clot Limiting vs. Clot Busting: The Role of Catheter-directed Thrombolysis in Treating Intermediate- to High-risk Pulmonary Embolism

Outcomes with catheter‐directed thrombolysis compared with anticoagulation alone in patients with acute deep venous thrombosis

The authors aimed to investigate the benefits and risks of catheter-directed thrombolysis (CDT) in acute deep venous thrombosis (DVT). The role of CDT in the management of DVT is evolving. Data on CDT versus anticoagulation alone in acute DVT is sparse. We performed a systematic review and meta-analysis of published studies that compared CDT to anticoagulation alone in patients with acute DVT. We included 11 studies (four randomized control trials [RCTs] and seven observational studies) with a total of 8,737 patients. During hospital stay, patients who received CDT had higher odds of major bleeding (2.5% vs. 1.6%; OR 1.46, 95% CI [1.07, 1.98], p = .02), blood transfusion (10.8% vs. 6.2%; OR 1.8, 95% CI [1.52, 2.13], p < .001), and thromboembolism (15.5% vs. 10%; OR 1.67, 95% CI [1.47, 1.91], p < .001) compared with anticoagulation alone. At 6-month follow-up, patients who received CDT had higher venous patency (71.1% vs. 37.7%; OR 5.49, 95% CI [2.63, 11.5], p < .001) and lower postthrombotic syndrome (PTS; 27% vs. 40.7%; OR 0.44, 95% CI [0.22, 0.86], p = .02). During a mean follow-up duration of 30.5 ± 28 months, CDT group continued to have higher venous patency (79.6% vs. 71.8%; OR 3.79, 95% CI [1.54, 9.32], p = .004) and lower PTS (44.7% vs. 50.5%; OR 0.43, 95% CI [0.23, 0.78], p = .006), but no difference in thromboembolism. Compared with anticoagulation alone, CDT for patients with acute DVT was associated with a higher risk of complications, but a higher rate of venous patency and lower risk of postthrombotic syndrome at 2.5 years follow-up.

Role of Catheter-Directed Thrombolysis in Patients With Acute on Chronic Limb Ischemia Due to Buerger′S Disease with no Option Critical Limb Ischemia

Role of Catheter-Directed Thrombolysis in Patients With Acute on Chronic Limb Ischemia Due to Buerger′S Disease with no Option Critical Limb Ischemia

Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis.

The treatment for iliofemoral deep venous thrombosis (DVT) is challenging, as the use of anticoagulation alone can be insufficient for restoring venous patency and thus lead to prolongation of acute symptoms and an increased risk of chronic complications, including venous insufficiency and postthrombotic syndrome (PTS). In these cases, earlier and more complete thrombus removal can ameliorate acute symptoms and reduce long-term sequelae. Endovascular therapies involving the use of pharmacologic, mechanical, and combined pharmacomechanical modalities have been developed to achieve these goals. The most frequently used of these techniques, catheter-directed thrombolysis (CDT), involves the infusion of a thrombolytic agent through a multiple-side-hole catheter placed within the thrombosed vein to achieve high local doses and thereby break down the clot while minimizing systemic thrombolytic agent exposure. Randomized controlled trial results have indicated decreased PTS rates and improved venous patency rates in patients treated with CDT compared with these rates in patients treated with anticoagulation. The use of newer pharmacomechanical techniques, as compared with conventional CDT, reduces procedural times and thrombolytic agent doses and is the subject of ongoing investigations. Endovascular thrombus removal techniques offer a means to improve venous valvular function and decrease the risk of debilitating long-term complications such as PTS and are a promising option for treating patients with iliofemoral DVT. (©)RSNA, 2016.

Invited Commentary on "Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis".

Invited Commentary on "Role of Catheter-directed Thrombolysis in Management of Iliofemoral Deep Venous Thrombosis".

CATHETER-DIRECTED THROMBOLYSIS (CDT) VERSUS THROMBOLYSIS TO TREAT PULMONARY EMBOLISM: A PROPENSITY SCORE-MATCHED ANALYSIS FROM THE NATIONWIDE INPATIENT SAMPLE

The role of catheter-directed thrombolysis in the treatment of pulmonary embolism is controversial, and real world outcomes are unknown. We used Nationwide Inpatient Sample database from 2000 to 2012 to identify all patients aged ≥ 18 years with PE. We compared patients treated with CDT against

NATIONAL TRENDS AND COMPARATIVE OUTCOMES OF CATHETER-DIRECTED THROMBOLYSIS PLUS ANTICOAGULATION VERSUS ANTICOAGULATION ALONE IN THE TREATMENT OF CAVAL DEEP VEIN THROMBOSIS

The nationwide acute safety outcomes and the role of catheter-directed thrombolysis (CDT) in treatment of caval deep vein thrombosis (DVT) are unknown. We used the Nationwide Inpatient Sample (NIS) database from 2005 to 2011 to identify all patients admitted with a principal discharge diagnosis of

Early re-presentations and the potential role of catheter-directed thrombolysis in patients diagnosed with a lower limb deep vein thrombosis: a single-centre experience

Catheter-directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) restores venous patency, reduces the risk of the post-thrombotic syndrome and may reduce longer term treatment costs. This study assessed the potential role of CDT in patients with DVT with regard to representation following the index event. A retrospective review of all patients with a positive lower limb DVT scan. Potential suitability of each patient to undergo CDT was based on well-recognized inclusion/exclusion criteria. In total, 1689 patients underwent a DVT-specific lower limb venous duplex. A total of 269 were found to have a DVT. Fifty-three of these patients met the inclusion criteria for CDT (only 2 underwent CDT). Fifty-nine of the 269 patients with an index DVT re-presented to our institution with a venous thromboembolism-related clinical event. These patients were significantly younger than those who did not reattend. A higher proportion of patients who represented were deemed suitable for CDT for the index DVT compared with those who did not represent (17/59 versus 36/210; P = 0.04). This pragmatic study highlights the fact that significant number of patients return to secondary care with actual/perceived complications following initial diagnosis and treatment of a DVT which may have been amenable to CDT.

Abstract 19358: Comparative Outcomes of Catheter-Directed Thrombolysis plus Anticoagulation versus Anti-Coagulation Alone in the Treatment of Lower Extremity Proximal Deep Vein Thrombosis

Background: The role of catheter-directed thrombolysis (CDT) in treatment of acute proximal deep vein thrombosis (DVT) is controversial and national rates of in-hospital mortality and acute complications in these patients are unknown. Methods: We used the Nationwide Inpatient Sample (NIS) database from 2005 to 2009 to identify all patients admitted with a principal diagnosis of proximal or caval DVT. In these patients, we evaluated the trends in the utilization rates of CDT and in-hospital outcomes. We compared in-hospital outcomes between the matched groups treated with CDT plus anticoagulation (Group A - 10,730 patients) versus anticoagulation alone (Group B - 10,730). We used propensity scores and Elixhauser comorbidity risk index to match the two treatment groups. Results: Among a total of 368,974 patients admitted with lower extremity proximal or caval DVT, 3.7% (13,542) underwent CDT. The national CDT utilization rates gradually increased from 2.3% in 2005 to 5.1% in 2009. The groups that were less likely to be treated with thrombolysis included females (3.5% versus 3.9%; p &lt;0.0001), patients greater than 65 years of age (3% versus 6.6%; p &lt; 0.0001), and African Americans (2.9% versus 3.7%; p&lt;0.0001). The outcomes analysis of the matched groups showed that in-hospital mortality was similar in the CDT group than in the anti-coagulation alone group (1.2% versus 0.9%; p= 0.287). In the CDT group, a decline in mortality was noted from 2.0% in 2005 to 0.6% in 2006. The rates of blood transfusion, pulmonary embolism, intracranial bleeding, and vena caval filter placement were significantly higher in the CDT group. The CDT group also had significantly increased length of stay (7±2.3 versus 4.9±1.9 days; P &lt; 0.00001) and hospital charges ($85416 ± 67940 versus $26841 ± 43872; p&lt;0.0001) than the anticoagulation alone group. Conclusions: In this observational study we found that in-hospital morbidity with catheter-directed thrombolysis remains higher than anticoagulation alone, however recently a significant improvement in in-hospital mortality has been noted.