The article’s title is Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. This is a meta-analysis published in Cochrane Database in January 2021. The first author is Cathryn Broderick. The study’s objective is to assess the effect of thrombolytic clot removal and anticoagulation compared to anticoagulation alone for the management of DVT of the lower limb. The review included a total of 19 RCTs with 1943 participants. The primary outcomes include complete clot lysis, bleeding complications, and post-thrombotic syndrome. Patient were followed immediately (36 hours – 1 month), intermediate (6 months – 5 years), and late (5 years or more).
The thrombolytic strategies include systemic, loco-regional, catheter-directed and pharmacochemical thrombolysis. The most common agents included in the study are streptokinase and tPA. The most common anticoagulant in the studies is heparin. They found that complete clot lysis was more likely following thrombolysis at both early and intermediate time points (32% in the anticoagulation group vs. 48% in the thrombolysis group). 6.7% of participants in the thrombolysis group experienced a bleeding complication compared to 2.2% of participants in anticoagulation group. But the bleeding risk has decreased in time with the use of stricter exclusion criteria. Post-thrombotic syndrome is slightly less in thrombolytic group during late follow-up.
