Deep Vein Thrombosis: Pharmacomechanical Therapy With/Without Catheter-Directed Thrombolysis

INTRODUCTION: This study aimed to compare the early and mid-term outcomes of patients diagnosed with acute and subacute deep vein thrombosis (DVT) treated with pharmacomechanical thrombectomy (PMT) only versus combined pharmacomechanical thrombectomy and catheter-directed thrombolysis (PMT+CDT).
METHODS: In this retrospective study conducted between January 2018 and January 2021, 60 patients diagnosed with acute or subacute iliofemoral DVT were included. Patients meeting the inclusion criteria underwent PMT alone or PMT combined with CDT. Thirty patients underwent PMT, while the other 30 received additional CDT following PMT. Demographic data, clinical findings, Doppler ultrasound results, Villalta scores, and complications were evaluated at 1, 6, and 12 months post-treatment.
RESULTS: The mean age was 61.2 years in the PMT group, comprising 14 males (46.6%) and 16 females (53.3%). At the 1-month follow-up, venous patency <70% was significantly more common in the PMT group (43.33%; p=0.032). At 6 and 12 months, patency rates ≥90% were significantly higher in the PMT+CDT group (63.34% and 66.67%, respectively; p=0.033). At 12 months, the rate of post-thrombotic syndrome (PTS) was significantly lower in the PMT+CDT group (33.33%; p=0.038). Although minor complications such as bleeding and transient renal dysfunction were observed in both groups, no significant differences were found regarding major complications or pulmonary embolism.
DISCUSSION AND CONCLUSION: The combination of PMT and CDT was more effective in maintaining venous patency and reducing the risk of PTS compared to PMT alone. Although minor bleeding risks were observed, the combined approach appears to offer superior clinical outcomes. Further multicenter, large-scale studies are warranted to validate these findings.

Keywords: Deep Vein Thrombosis, Thrombectomy, Thrombolytic Therapy, Postthrombotic Syndrome, Treatment Outcome