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Additional catheter-directed thrombolysis benefited patients with DVT

Issue: January 25, 2012

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53rd ASH Annual Meeting

SAN DIEGO — Supplementary catheter-directed thrombolysis with alteplase significantly reduced the rate of post-thrombotic syndrome in patients with deep vein thrombosis compared with standard treatment alone, according to data presented here.

In a randomized study of 209 patients aged 19 to 75 years with a first-time acute iliofemoral DVT, researchers found that additional treatment with catheter-directed thrombolysis — compared with standard treatment of oral anticoagulation therapy and elastic compression stockings — reduced the risk for post-thrombotic syndrome in patients with DVT in their lower limbs.

In this trial, patients were divided randomly into treatment arms: Treatment arm A (the catheter-directed thrombolysis-treated arm) had 101 patients and arm B (control arm treated with oral anticoagulant and elastic compression stockings) had 108 patients. At the completion of the 24 months’ follow-up, data were available for 90 patients treated with catheter-directed thrombolysis and 99 control patients.

According to researchers, 41.1% of patients treated with catheter-directed thrombolysis presented symptoms of post-thrombotic syndrome compared with 55.6% of control patients; the difference in post-thrombotic syndrome incidence corresponds to an absolute risk reduction of 14.4% (95% CI, 0.2-27.9) in patients treated with catheter-directed thrombolysis, and the number needed to treat was seven patients (95% CI, 4-502).

Although catheter-directed thrombolysis resulted in successful lysis in most patients with iliofemoral DVT, it also involved an additional risk for bleeding. Twenty bleeding complications were reported, yet none caused serious complications, and there were no pulmonary emboli, strokes or deaths related to catheter-directed thrombolysis treatment. After 6 months of follow-up, post-thrombotic syndrome developed in 36.9% of patients who no longer had a clotted vein, compared with 61.3% of patients who still experienced clotting.

“The results of our trial show that additional treatment with [catheter-directed thrombolysis] significantly reduces the risk of [post-thrombotic syndrome] in patients with DVT, compared with standard treatment alone,” said Per Morten Sandset, MD, PhD, senior researcher and the head of research at the Clinic of Cancer, Surgery, and Transplantation at Oslo University Hospital in Norway. “Although [catheter-directed thrombolysis] is a promising treatment option for patients with iliofemoral DVT, the therapy also increases the risk of bleeding, emphasizing the importance of patient selection and safety when performing [catheter-directed thrombolysis] procedures. Our findings suggest that [catheter-directed thrombolysis] should be considered in patients with upper thigh or pelvic DVT.”

Disclosure: The researchers reported no relevant financial disclosures.

For more information:

• Enden T. Abstract #LBA-1. Presented at: 53rd Annual Meeting of the American Society of Hematology; Dec. 10-13, 2011; San Diego.

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