Comparative study of catheter<b>-</b>directed thrombolysis and anticoagulation alone in the treatment of acute proximal deep venous thrombosis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

ZENG Yanzhang ¹ ,  YUAN Ping ¹ , HE Qiang ²

1. Department of Vascular and Thyroid Surgery, Guizhou Provincial People’s Hospital, Guiyang 550002, P. R. China;
2. Department of Intervention, Guizhou Provincial People’s Hospital, Guiyang 550002, P. R. China;

Corresponding author：

YUAN Ping, Email: yuanpinggzsy@163.com

Keywords：

acute proximal deep vein thrombosis; catheter-directed thrombolysis; anticoagulation; post-thrombotic syndrome; quality of life

DOI：

10.7507/1007-9424.202309022

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Objective To compare the effect of catheter-directed thrombolysis (CDT) combined with anticoagulation (AC) and AC in the treatment of acute proximal deep venous thrombosis (APDVT) of the lower extremities. Methods The clinical data of 184 APDVT patients treated in Guizhou Provincial People’s Hospital from January 2017 to December 2022 were retrospectively collected. According to the treatment methods, the patients were divided into CDT group (n=82, CDT combined with AC) and AC group (n=102, AC alone). The prognosis indicators such as the incidence of bleeding events, the incidence of post-thrombotic syndrome (PTS), Villalta score, venous clinical severity score (VCSS) and chronic lower limb venous insufficiency questionnaire (CIVIQ) score were compared between the two groups. Results Compared with the AC group, the CDT group had a higher incidence of bleeding events [11.0% (9/82) vs. 2.9% (3/102)], a shorter time to detumescent [(2.8±1.2) d vs. (7.2±1.9) d], and lower VS score [3 (2,4) vs. 3 (2, 7)], VCSS score [2.0 (1.7, 4.0) vs. 3.0 (2.0, 5.2)] and postoperative venous patency score [1 (1, 2) vs. 2 (1, 3)], and higher CIVIQ score [80.0 (77.0, 86.0) vs. 71.5 (68.0, 78.0)], P<0.05. However, there were no significant differences in the incidence of PTS [28.2% (22/78) vs. 36.5% (35/96)] and thrombosis recurrence rate [9.0% (7/78) vs. 11.5% (11/96)] between the two groups (P>0.05). Conclusion CDT can relieve the symptoms and improve the quality of life of APDVT faster than AC, but it is necessary to strictly grasp the indications of thrombolysis to reduce the risk of bleeding.

Citation： ZENG Yanzhang, YUAN Ping, HE Qiang. Comparative study of catheter-directed thrombolysis and anticoagulation alone in the treatment of acute proximal deep venous thrombosis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2024, 31(3): 315-319. doi: 10.7507/1007-9424.202309022 Copy

1.	Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet, 2016, 388(10063): 3060-3073.
2.	Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
3.	Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
4.	中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第三版). 中国血管外科杂志 (电子版), 2017, 9(4): 250-257.
5.	Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
6.	Lattimer CR, Kalodiki E, Azzam M, et al. Validation of the Villalta scale in assessing post-thrombotic syndrome using clinical, duplex, and hemodynamic comparators. J Vasc Surg Venous Lymphat Disord, 2014, 2(1): 8-14.
7.	Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
8.	Watanabe S, Nishio S, Tsuji T, et al. Effect of transluminal injection of foam sclerotherapy combined with endovenous thermal ablation of varicose veins. J Vasc Surg Venous Lymphat Disord, 2020, 8(3): 494.
9.	Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. J Vasc Surg, 2007, 46(5): 1065-1076.
10.	Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360, 361-362.
11.	Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
12.	Li FH, Zhao Y, Wang XH, et al. Risk factors associated with symptomatic pulmonary embolism of catheter directed thrombolysis for lower extremity deep venous thrombosis. Eur J Vasc Endovasc Surg, 2015, 50(5): 658-663.
13.	Staniszewska A, Onida S, Lane T, et al. The good, bad and the ugly of the acute venous thrombosis: thrombus removal with adjunctive catheter-directed thrombolysis trial from the viewpoint of clinicians. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 912-918.
14.	Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-e71.
15.	Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783.
16.	Chen G, Shi W, He X, et al. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding. Exp Ther Med, 2017, 13(2): 751-758.
17.	May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
18.	章杰, 张喜成. 血栓性髂静脉狭窄的诊疗现状与趋势. 中国普外基础与临床杂志, 2019, 26(3): 369-373.
19.	刘坤, 王小凯, 陈军, 等. 导管溶栓与系统溶栓治疗急性下肢深静脉血栓形成的疗效对比观察. 中国普外基础与临床杂志, 2017, 24(3): 307-311.
20.	刘强, 程英升, 王永利. 腔内血栓清除治疗急性下肢深静脉血栓形成研究进展. 介入放射学杂志, 2018, 27(8): 797-800.
21.	Notten P, Ten Cate-Hoek AJ, Arnoldussen CWKP, et al. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial. Lancet Haematol, 2020, 7(1): e40-e49.
22.	Pouncey AL, Gwozdz AM, Johnson OW, et al. Angiojet pharmacomechanical thrombectomy and catheter directed thrombolysis vs. catheter directed thrombolysis alone for the treatment of iliofemoral deep vein thrombosis: a single centre retrospective cohort study. Eur J Vasc Endovasc Surg, 2020, 60(4): 578-585.
23.	Kahn SR, Julian JA, Kearon C, et al. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2020, 8(1): 8-23.
24.	Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
25.	Gogalniceanu P, Johnston CJ, Khalid U, et al. Indications for thrombolysis in deep venous thrombosis. Eur J Vasc Endovasc Surg, 2009, 38(2): 192-198.

1. Di Nisio M, van Es N, Büller HR. Deep vein thrombosis and pulmonary embolism. Lancet, 2016, 388(10063): 3060-3073.
2. Vedantham S, Goldhaber SZ, Julian JA, et al. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med, 2017, 377(23): 2240-2252.
3. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST Guideline and Expert Panel Report. Chest, 2016, 149(2): 315-352.
4. 中华医学会外科学分会血管外科学组. 深静脉血栓形成的诊断和治疗指南 (第三版). 中国血管外科杂志 (电子版), 2017, 9(4): 250-257.
5. Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg, 1995, 21(4): 635-645.
6. Lattimer CR, Kalodiki E, Azzam M, et al. Validation of the Villalta scale in assessing post-thrombotic syndrome using clinical, duplex, and hemodynamic comparators. J Vasc Surg Venous Lymphat Disord, 2014, 2(1): 8-14.
7. Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
8. Watanabe S, Nishio S, Tsuji T, et al. Effect of transluminal injection of foam sclerotherapy combined with endovenous thermal ablation of varicose veins. J Vasc Surg Venous Lymphat Disord, 2020, 8(3): 494.
9. Comerota AJ, Gravett MH. Iliofemoral venous thrombosis. J Vasc Surg, 2007, 46(5): 1065-1076.
10. Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg, 2007, 33(3): 351-360, 361-362.
11. Kakkos SK, Gohel M, Baekgaard N, et al. Editor’s choice—European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg, 2021, 61(1): 9-82.
12. Li FH, Zhao Y, Wang XH, et al. Risk factors associated with symptomatic pulmonary embolism of catheter directed thrombolysis for lower extremity deep venous thrombosis. Eur J Vasc Endovasc Surg, 2015, 50(5): 658-663.
13. Staniszewska A, Onida S, Lane T, et al. The good, bad and the ugly of the acute venous thrombosis: thrombus removal with adjunctive catheter-directed thrombolysis trial from the viewpoint of clinicians. J Vasc Surg Venous Lymphat Disord, 2020, 8(6): 912-918.
14. Haig Y, Enden T, Grøtta O, et al. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol, 2016, 3(2): e64-e71.
15. Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev, 2021, 1(1): CD002783.
16. Chen G, Shi W, He X, et al. Feasibility of continuous, catheter-directed thrombolysis using low-dose urokinase in combination with low molecular-weight heparin for acute iliofemoral venous thrombosis in patients at risk of bleeding. Exp Ther Med, 2017, 13(2): 751-758.
17. May R, Thurner J. The cause of the predominantly sinistral occurrence of thrombosis of the pelvic veins. Angiology, 1957, 8(5): 419-427.
18. 章杰, 张喜成. 血栓性髂静脉狭窄的诊疗现状与趋势. 中国普外基础与临床杂志, 2019, 26(3): 369-373.
19. 刘坤, 王小凯, 陈军, 等. 导管溶栓与系统溶栓治疗急性下肢深静脉血栓形成的疗效对比观察. 中国普外基础与临床杂志, 2017, 24(3): 307-311.
20. 刘强, 程英升, 王永利. 腔内血栓清除治疗急性下肢深静脉血栓形成研究进展. 介入放射学杂志, 2018, 27(8): 797-800.
21. Notten P, Ten Cate-Hoek AJ, Arnoldussen CWKP, et al. Ultrasound-accelerated catheter-directed thrombolysis versus anticoagulation for the prevention of post-thrombotic syndrome (CAVA): a single-blind, multicentre, randomised trial. Lancet Haematol, 2020, 7(1): e40-e49.
22. Pouncey AL, Gwozdz AM, Johnson OW, et al. Angiojet pharmacomechanical thrombectomy and catheter directed thrombolysis vs. catheter directed thrombolysis alone for the treatment of iliofemoral deep vein thrombosis: a single centre retrospective cohort study. Eur J Vasc Endovasc Surg, 2020, 60(4): 578-585.
23. Kahn SR, Julian JA, Kearon C, et al. Quality of life after pharmacomechanical catheter-directed thrombolysis for proximal deep venous thrombosis. J Vasc Surg Venous Lymphat Disord, 2020, 8(1): 8-23.
24. Meissner MH, Gloviczki P, Comerota AJ, et al. Early thrombus removal strategies for acute deep venous thrombosis: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2012, 55(5): 1449-1462.
25. Gogalniceanu P, Johnston CJ, Khalid U, et al. Indications for thrombolysis in deep venous thrombosis. Eur J Vasc Endovasc Surg, 2009, 38(2): 192-198.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparative study of catheter-directed thrombolysis and anticoagulation alone in the treatment of acute proximal deep venous thrombosis

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