Risk of Post-thrombotic Syndrome after Iliofemoral Thrombosis Treated by Pharmacomechanical Thrombectomy or Catheter Directed Thrombolysis Alone: A Systematic Review and Meta-analysis.

Abstract

This systematic review aimed to compare the effects of pharmacomechanical thrombectomy with catheter directed thrombolysis (CDT) for iliofemoral deep vein thrombosis (DVT) in preventing post-thrombotic syndrome (PTS). PubMed, Embase, and the Cochrane Library from inception until September 2024. A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines by searching PubMed, Embase, and the Cochrane Library from inception until September 2024 for studies comparing pharmacomechanical thrombectomy vs. CDT in patients with DVT. The primary outcome was overall risk of PTS, while secondary outcomes included the risks of different PTS classifications and safety outcomes. Safety outcomes included bleeding events, haemoglobinuria, and acute kidney injury (AKI). Risk of bias was evaluated with the ROBINS-I tool. Study quality was assessed by the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Thirteen retrospective cohort studies with 1 742 patients were included. Use of pharmacomechanical thrombectomy for DVT treatment was associated with a lower risk of PTS compared with CDT alone (odds ratio [OR] 0.55, 95% confidence interval [CI] 0.43 - 0.71; p < .001). Pharmacomechanical thrombectomy was associated with a reduced risk of mild PTS (OR 0.56, 95% CI 0.37 - 0.86; p = .008), moderate to severe PTS and or venous ulcers (OR 0.40, 95% CI 0.25 - 0.66; p < .001), and severe PTS and or venous ulcers (OR 0.34, 95% CI 0.19 - 0.59; p = .001). A similar trend was observed for reduced risk of moderate PTS (OR 0.57, 95% CI 0.31 - 1.04; p = .067). Pharmacomechanical thrombectomy was associated with a lower risk of bleeding events compared with CDT (OR 0.58, 95% CI 0.41 - 0.81; p = .001), while haemoglobinuria (OR 20.08, 95% CI 4.57 - 88.19; p < .001) and AKI (OR 3.00, 95% CI 1.12 - 8.01; p = .029) occurred more frequently. GRADE certainty was low or very low for all outcomes. Compared with CDT, pharmacomechanical thrombectomy may reduce the risk of PTS of any degree in patients with DVT, while large and well designed studies are needed owing to the very low certainty of evidence.