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THE USE OF ULTRASOUND ACCELERATED
THROMBOLYSIS
VS.
CATHETER GUIDED THROMBOLYSIS FOR
THE TREATMENT OF DVT OF LOWER EXT.
Mohammad M. Ansari, MD
Assistant Professor of Medicine
Director; Cardiac Cath Lab, Structural Heart Program.
And Interventional Cardiology Research.
Texas Tech University Health Sciences Center
Mac.ansari@ttuhsc.edu
Disclosures
No relevant disclosures.
I do NOT have any potential conflict of
interest
Introduction
Ultrasound-facilitated thrombolysis (UAT) can benefit
the treatment of deep vein thrombosis (DVT)
Currently systemic anticoagulation with combination of
catheter direct thrombolysis (CDT) has been used as
the standard treatment
“This therapy provides additional benefit of preventing
post-thrombotic syndrome.”
Cost Effectiveness Compared to
Standard Anticoagulation
• It increases the cost by 10%
• It decreases the post thrombotic syndrome
by 30%
• It decreases recurrence of DVT by 10%
• Increases quality of life by 10%
Enden et al. J Thromb Haemost. 2013
Objective:
We aimed to do a meta-analysis comparing the
clinical outcomes between UAT and CDT
Methods
Systematic search through Pub Med and
Cochrane database using all clinical data
Reports of outcomes of Catheter-directed
thrombolysis and ultra-sound-accelerated
thrombolysis (UAT) for DVT of lower
extremities
Performed in accordance with established
methods for systematic reviews in
cardiovascular medicine
Methods
The following medical subject heading terms
were included for a MEDLINE search:
1. Ultra-sound accelerated thrombolysis
2. Catheter direct thrombolysis
3. DVT
4. Lower extremity
5. Endovascular therapy
( -neither language nor patient population size
restriction .)
Methods
• Data extraction and quality assessment were
independently completed by the two teams
(DCG and MMA)
• Project coordinator (DCG) reviewed all the
studies to ensure that they met the inclusion
criteria
• Disagreements were resolved by consensus
(10% of the time).
Methods
Inclusion Criteria
1. Studies that directly compared UAT to CDT
2. Patients treated for DVT of the lower
extremities
3. Reports of the primary and/or secondary
outcomes.
Methods
• Exclusion criteria:
1. Reports of CDT only, without
comparison to UAT and vice-versa
2. Overlapping patient population,
identified by studies developed over the
same period of time, with common
authors or common study centers. In that
case, only the study with a greater
number of patients was included
Primary Endpoint
1. Failure of ≥ 50% thrombus
reduction
2. Repeat target vein
thrombolysis.
Secondary Endpoints
1. Major bleeding (requiring blood transfusion)
2. Minor bleeding (no blood transfusion)
3. Additional angioplasty (PTA+ stent)
4. Mean days of hospital stay
Statistical Analysis:
• Pooled treatment effects were estimated using odd-ratio (OR) with the
Mantel–Haenszel risk ratio in a random-effects model.
• Heterogeneity was assessed using chi-square tests and I2 statistic
• Defined I2 < 50% as low heterogeneity according to the Cochrane
Handbook of Systematic Reviews.
• Fixed effect analysis when I2 up to 50% and P at least 0.10, otherwise
we used random effect
• Cochrane Handbook of Systematic Reviews and RevMan 5.2
Baseline Characteristics
CDT UAT
Patients
Female sex, % 64 63
Mean age±SD 42.2±5.5 42.3±6.1
Involved Segments
Aorto-iiliac,% 53 52
Femoro-popliteal,% 39 35
Comorbidities
Tobacco abuse,% 30 33
HTN,% 20 18
History of DVT,% 38 35
Results
5 studies :
Total of 342 patients: 157 in the CDT group and
185 in the UAT group
Mean follow-up was 12±2.5 months
Repeat Target Vein Thrombolysis
Provisional Stent
Hospital Stay
Conclusion:
Newer thrombolysis techniques can improve outcomes of
acute DVT treatment.
UAT might be associated with better re-stenosis rates
given better thrombus burden reduction. This might
imply in less angioplasty and stents use
Complication rates were similar between both groups
In-deep analysis and further randomized trials should be
pursued to determine these benefits
THANKS!
THE USE OF ULTRASOUND ACCELERATED
THROMBOLYSIS
VS.
CATHETER GUIDED THROMBOLYSIS FOR
THE TREATMENT OF DVT OF LOWER EXT.
Mohammad M. Ansari, MD
Assistant Professor of Medicine
Director; Cardiac Cath Lab, Structural Heart Program.
And Interventional Cardiology Research.
Texas Tech University Health Sciences Center
Mac.ansari@ttuhsc.edu
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