Most recent update: Sunday, April 29, 2018 - 14:56

You are here

CDT for DVT

Study shows benefits of catheter- directed thrombolysis for DVT

The multivariate analysis revealed age was the predominant risk factor for bleeding, with no significant difference in mortality and pulmonary embolism

A study published in the Journal of Vascular Surgery Venous and Lymphatic Disorders has highlighted the benefits of catheter-directed thrombolysis (CDT) in the treatment of DVT. This is in contrast to findings in the ATTRACT (Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis) trial that suggest most patients will not benefit significantly from more aggressive treatment of DVT.

“The results of our single-centre study suggest that CDT is superior to standard anticoagulation alone in restoring patency to the femoral-popliteal venous segment in lower extremity DVT that was associated with proximal extension,” said Dr Mayin Lin, an author of the study. “This was achieved without an increased risk of bleeding associated with the use of tPA.”

The objective of the research was to evaluate the efficacy of CDT using tissue plasminogen activator vs standard anticoagulation alone in patients with lower extremity DVT involving the femoral-popliteal segment. The investigators performed a retrospective review of patients referred to the vascular surgery service with lower extremity DVT from 2006 to 2015.

Patients who had DVT involving the femoral-popliteal segment were identified, including some patients who had concomitant involvement of iliofemoral and tibial veins. Patients with pure iliofemoral and tibial vein DVT were excluded from this analysis. They then compared the outcomes between patients who received thrombolytic therapy using tissue plasminogen activator and patients who received standard anticoagulation alone was performed.

The primary outcomes measured were restoration of patency of the femoral-popliteal segment at three months, incidence of post-thrombotic syndrome (PTS), and valvular dysfunction. Secondary outcomes were incidence of bleeding, in-hospital mortality, and pulmonary embolism.

The study included 191 patients (CDT, n=89; anticoagulation alone, n=102), and most patients with thrombus involving the femoral-popliteal segment also had proximal venous segment involvement, with 93% of the patient cohort having proximal iliofemoral DVT.

Patients who did not receive CDT were older (mean age of 64 years vs 51 years; p<0.001) and had more associated comorbidities, such as diabetes, immobility, and cancer. A significant number of patients who received CDT had a positive family history for DVT (21.3% vs 8.8%; p=0.023), and it was more likely to be their first episode of DVT (73.0% vs 55.9%; p=0.016).

Patients who received CDT were more likely to have restoration of patency (74.7% vs 11.1%; p<0.001) and lower incidence of PTS (21.3% vs 73.4%; p<0.001) and valvular dysfunction (23.0% vs 66.7%; p<0.001) compared with patients who were treated with anticoagulation alone.

Incidence of bleeding was significantly more for patients treated with anticoagulation alone (14.7% vs 5.6%; p=0.018) compared with patients who received CDT. The multivariate analysis revealed age was the predominant risk factor for bleeding, with no significant difference in mortality and pulmonary embolism.

“The results of our single-center study suggest that CDT is superior to standard anticoagulation alone in restoring patency to the femoral-popliteal venous segment in lower extremity DVT that was associated with proximal extension,” the paper concludes. “Patients who received CDT also had lower incidence of PTS and less valve dysfunction. This was achieved without an increased risk of bleeding associated with the use of tPA compared with anticoagulation alone. Age was the major factor predicting risk of bleeding in either group. The results of this study may not be applicable to patients with pure femoral-popliteal venous segment DVT because only 3% of patients had this finding.”

To access this paper, please click here