P-129 - META-ANALYSIS ON CATHETER-DIRECTED THROMBOLYSIS FOR ACUTE PROXIMAL DEEP VEIN THROMBOSIS IN THE REDUCTION OF POST-THROMBOTIC SYNDROME.

TOPIC:
Thrombosis
AUTHORS:
Javed A. (Imperial College London ~ London ~ United Kingdom) , Machin M. (Imperial College London ~ London ~ United Kingdom) , Salim S. (Imperial College London ~ London ~ United Kingdom) , Onida S. (Imperial College London ~ London ~ United Kingdom) , Gwozdz A. (Imperial College London ~ London ~ United Kingdom) , Shalhoub J. (Imperial College London ~ London ~ United Kingdom) , Davies A. (Imperial College London ~ London ~ United Kingdom)
Introduction:
Post thrombotic syndrome (PTS) is a common complication of proximal deep vein thrombosis (DVT) that results in severe morbidity for the patient as well as a negative influence on their quality of life. Evidence supporting catheter-directed thrombolysis (CDT) in the prevention of PTS is conflicting. Despite this, the rate of CDT is increasing. A meta-analysis of trials assessing the efficacy of CDT for proximal acute DVT in the prevention of PTS was undertaken.
Methods:
This meta-analysis was undertaken aligning with PRISMA guidelines following a pre-registered protocol on PROSPERO. Online searches of Medline and Embase databases were performed, and grey literature was identified up to March 2022. Included articles were randomised-controlled trials that use of CDT with additional anticoagulation versus anticoagulation alone and had a determined follow up period. Outcomes of interest were PTS development, moderate-severe PTS, major bleeding episodes, quality of life measures. Subgroup analyses were performed on trials reporting on iliofemoral DVTs alone. Meta-analysis was performed using a fixed-effects model. Two reviewers independently undertook Cochrane Risk of Bias and GRADE assessments.
Results:
Three studies were included in the final meta-analysis, the CaVENT, ATTRACT and CAVA trials comprising 987 patients. Patients undergoing CDT had a reduced risk of PTS (RR 0.84, 95% CI: 0.75 - 0.95, number needed to treat (NNT): 12) as well as a reduced risk of developing moderate-severe PTS (RR 0.61, 95% CI: 0.49 - 0.78, NNT: 10). CDT increased the risk of having a major bleed (RR 2.02, 95% CI: 1.07-3.81, number-needed to harm (NNH): 37). In the iliofemoral subgroup analysis, there was a reduced risk of developing PTS and moderate severe PTS but these results did not reach the level of significance required (p=0.12 and p=0.05 respectively). There was no significant difference in quality-of-life score VEINES-QOL sym between the two groups (p=0.51). There was a high certainty in the outcomes as assessed by GRADE.
Conclusion:
Pooling of current best evidence suggests that CDT in acute proximal DVT reduces the rate of PTS and moderate-to-severe PTS with a NNT of 12 and 10 respectively. However, this is complicated by a significantly higher rate of major bleeding with a NNH of 37. This evidence supports patient selection of those with proximal DVT and those with a low risk of major bleeding.
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