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