title: Treatment of acute iliofemoral deep vein thrombosis.
abstract: OBJECTIVE
  The objective of this systematic review and meta-analysis was to compare the efficacy of three available treatments for acute iliofemoral deep vein thrombosis (DVT): systemic anticoagulation, surgical thrombectomy, and catheter-directed thrombolysis.
  
  
  METHODS
  We searched electronic databases (MEDLINE, EMBASE, Cochrane CENTRAL, Web of Science, and Scopus) and sought additional references from experts. Eligible studies enrolled participants with acute iliofemoral DVT and measured the outcomes of interest. Reviewers working independently in duplicate extracted study characteristics, quality, and outcome data (death, pulmonary embolism, local complications, hemorrhagic complications, postthrombotic syndrome, pain, quality of life, and surrogate markers of venous function such as valve competence and patency). We pooled relative risks (RRs) from each study using the random effects model and estimated the 95% confidence intervals (CIs). Bayesian indirect comparison techniques were used to compare thrombectomy to catheter-directed thrombolysis.
  
  
  RESULTS
  We found 15 unique studies that fulfilled eligibility criteria. When compared to systemic anticoagulation, thrombectomy was associated with a statistically significant reduction in the risk of developing postthrombotic syndrome (RR, 0.67; 95% CI, 0.52-0.87), venous reflux (RR, 0.68; 95% CI, 0.46-0.99), and a trend for reduction in the risk of venous obstruction (RR, 0.84; 95% CI, 0.60-1.19). When compared to systemic anticoagulation, pharmacologic catheter-directed thrombolysis was associated with statistically significant reduction in the risk of postthrombotic syndrome (RR, 0.19; 95% CI, 0.07-0.48), venous obstruction (RR, 0.38; 95% CI, 0.18-0.37), and a trend for reduction in the risk of venous reflux (RR, 0.39; 95% CI, 0.16-1.00). Overall, the quality of evidence was low; downgraded due to the observational nature of the majority of studies, lack of comparability of study cohorts at baseline, loss to follow-up, imprecision, and indirectness of outcomes (surrogacy). There were insufficient data to compare the outcomes of thrombectomy to catheter-directed thrombolysis.
  
  
  CONCLUSIONS
  Low-quality evidence suggests that surgical thrombectomy decreases the incidence of postthrombotic syndrome and venous reflux. Catheter-directed pharmacologic thrombolysis decreases the incidence of postthrombotic syndrome and venous obstruction.
authors.affiliation: Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Edward T
authors.initials: ET
authors.lastname: Casey
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
authors.forename: Magaly
authors.initials: M
authors.lastname: Zumaeta-Garcia
authors.forename: Mohamed B
authors.initials: MB
authors.lastname: Elamin
authors.forename: Qian
authors.initials: Q
authors.lastname: Shi
authors.forename: Patricia J
authors.initials: PJ
authors.lastname: Erwin
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Peter
authors.initials: P
authors.lastname: Gloviczki
authors.forename: Mark
authors.initials: M
authors.lastname: Meissner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001499:Bayes Theorem; D019317:Evidence-Based Medicine; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D054070:Postthrombotic Syndrome / Q000209:etiology / Q000517:prevention & control; D018570:Risk Assessment; D012307:Risk Factors; D017131:Thrombectomy / Q000009:adverse effects; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000628:therapy*; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents