Coagulation-monitored, dose-adjusted catheter-directed thrombolysis or pharmaco-mechanical thrombus removal in deep vein thrombosis
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| Název: | Coagulation-monitored, dose-adjusted catheter-directed thrombolysis or pharmaco-mechanical thrombus removal in deep vein thrombosis |
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| Autoři: | Julian Kleine Wortmann, Stefano Barco, Riccardo M. Fumagalli, Davide Voci, Ulrike Hügel, Rahel Cola, David Spirk, Nils Kucher, Tim Sebastian |
| Přispěvatelé: | University of Zurich |
| Zdroj: | Vasa. |
| Informace o vydavateli: | Hogrefe Publishing Group, 2023. |
| Rok vydání: | 2023 |
| Témata: | Adult, Male, Venous Thrombosis, Catheters, 10031 Clinic for Angiology, 610 Medicine & health, Hemorrhage, Middle Aged, Iliac Vein, Aged [MeSH], Venous Thrombosis/therapy [MeSH], pharmaco-mechanical thrombectomy, Catheters/adverse effects [MeSH], Fibrinolytic Agents/therapeutic use [MeSH], Original communication, Male [MeSH], Venous Thrombosis/diagnostic imaging [MeSH], Thrombolytic Therapy/adverse effects [MeSH], Postthrombotic Syndrome/etiology [MeSH], Female [MeSH], Hemorrhage/chemically induced [MeSH], Thrombectomy/methods [MeSH], Adult [MeSH], Venous Thrombosis/complications [MeSH], Humans [MeSH], Treatment Outcome [MeSH], Retrospective Studies [MeSH], Middle Aged [MeSH], Iliac Vein/diagnostic imaging [MeSH], Catheter-directed thrombolysis, Iliac Vein/surgery [MeSH], Postthrombotic Syndrome/prevention, Thrombectomy/adverse effects [MeSH], deep vein thrombosis, endovascular treatment, 3. Good health, Postthrombotic Syndrome, Treatment Outcome, Fibrinolytic Agents, Humans, Female, Thrombolytic Therapy, Aged, Thrombectomy, Retrospective Studies |
| Popis: | Summary: 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. |
| Druh dokumentu: | Article Other literature type |
| Popis souboru: | ZORA238104.pdf - application/pdf |
| Jazyk: | English |
| ISSN: | 1664-2872 0301-1526 |
| DOI: | 10.1024/0301-1526/a001097 |
| DOI: | 10.5167/uzh-238104 |
| Přístupová URL adresa: | https://pubmed.ncbi.nlm.nih.gov/37847240 https://repository.publisso.de/resource/frl:6475951 https://www.zora.uzh.ch/id/eprint/238104/ https://doi.org/10.5167/uzh-238104 |
| Rights: | CC BY |
| Přístupové číslo: | edsair.doi.dedup.....0ab1b5ace7dc53e4af83ad9f010a2e7d |
| Databáze: | OpenAIRE |
Nájsť tento článok vo Web of Science | Abstrakt: | Summary: 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. |
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| ISSN: | 16642872 03011526 |
| DOI: | 10.1024/0301-1526/a001097 |