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Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials

Although the cornerstone treatment for deep vein thrombosis (DVT) remains anticoagulation, clinicians perform stenting or angioplasty (SA) in particular patients. To assess the effects of SA in this setting, we performed a systematic review of randomized controlled trials. METHODS: Based on the Coch...

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Autores principales: Flumignan, Ronald Luiz Gomes, Civile, Vinicius Tassoni, Areias, Libnah Leal, Flumignan, Carolina Dutra Queiroz, Amorim, Jorge Eduardo, Lopes, Renato Delascio, Nakano, Luis C. U., Baptista-Silva, Jose Carlos Costa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Lippincott Williams & Wilkins 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10237682/
https://www.ncbi.nlm.nih.gov/pubmed/37266612
http://dx.doi.org/10.1097/MD.0000000000033924
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author Flumignan, Ronald Luiz Gomes
Civile, Vinicius Tassoni
Areias, Libnah Leal
Flumignan, Carolina Dutra Queiroz
Amorim, Jorge Eduardo
Lopes, Renato Delascio
Nakano, Luis C. U.
Baptista-Silva, Jose Carlos Costa
author_facet Flumignan, Ronald Luiz Gomes
Civile, Vinicius Tassoni
Areias, Libnah Leal
Flumignan, Carolina Dutra Queiroz
Amorim, Jorge Eduardo
Lopes, Renato Delascio
Nakano, Luis C. U.
Baptista-Silva, Jose Carlos Costa
author_sort Flumignan, Ronald Luiz Gomes
collection PubMed
description Although the cornerstone treatment for deep vein thrombosis (DVT) remains anticoagulation, clinicians perform stenting or angioplasty (SA) in particular patients. To assess the effects of SA in this setting, we performed a systematic review of randomized controlled trials. METHODS: Based on the Cochrane standards, we searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, LILACS and IBECS databases, and trial registries. Our primary outcomes were post-thrombotic syndrome (PTS), venous thromboembolism (VTE) and all-cause mortality. RESULTS: We included 7 randomized controlled trial (1485 participants). There was no clinically significant difference between SA and best medical practice (BMP) for the additional treatment of acute DVT regarding PTS (standardized mean difference −7.87, 95% confidence interval [CI] −12.13 to −3.61; very low-certainty) and VTE (risk ratio [RR] 1.19, 95% CI 0.28–5.07, very low-certainty), and no deaths. Compared to BMP, the SA plus BMP and thrombolysis results in little to no difference in PTS (mean difference [MD] −1.07, 95% CI −1.12 to −1.02, moderate-certainty), VTE (RR 1.48, 95% CI 0.95–2.31, low-certainty), and mortality (RR 0.92, 95% CI 0.34–2.52, low-certainty). There was no clinical difference between stenting and BMP for chronic DVT regarding PTS (MD 2.73, 95% CI −2.10 to 7.56, very low certainty) and no VTE and death events. CONCLUSIONS: SA results in little to no difference in PTS, VTE and mortality in acute DVT compared to BMP. The evidence regarding SA in chronic DVT and whether SA, compared to BMP and thrombolysis, decreases PTS and VTE in acute DVT is uncertain. Open Science Framework (osf.io/f2dm6)
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spelling pubmed-102376822023-06-03 Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials Flumignan, Ronald Luiz Gomes Civile, Vinicius Tassoni Areias, Libnah Leal Flumignan, Carolina Dutra Queiroz Amorim, Jorge Eduardo Lopes, Renato Delascio Nakano, Luis C. U. Baptista-Silva, Jose Carlos Costa Medicine (Baltimore) 7100 Although the cornerstone treatment for deep vein thrombosis (DVT) remains anticoagulation, clinicians perform stenting or angioplasty (SA) in particular patients. To assess the effects of SA in this setting, we performed a systematic review of randomized controlled trials. METHODS: Based on the Cochrane standards, we searched the Cochrane CENTRAL, MEDLINE, Embase, CINAHL, LILACS and IBECS databases, and trial registries. Our primary outcomes were post-thrombotic syndrome (PTS), venous thromboembolism (VTE) and all-cause mortality. RESULTS: We included 7 randomized controlled trial (1485 participants). There was no clinically significant difference between SA and best medical practice (BMP) for the additional treatment of acute DVT regarding PTS (standardized mean difference −7.87, 95% confidence interval [CI] −12.13 to −3.61; very low-certainty) and VTE (risk ratio [RR] 1.19, 95% CI 0.28–5.07, very low-certainty), and no deaths. Compared to BMP, the SA plus BMP and thrombolysis results in little to no difference in PTS (mean difference [MD] −1.07, 95% CI −1.12 to −1.02, moderate-certainty), VTE (RR 1.48, 95% CI 0.95–2.31, low-certainty), and mortality (RR 0.92, 95% CI 0.34–2.52, low-certainty). There was no clinical difference between stenting and BMP for chronic DVT regarding PTS (MD 2.73, 95% CI −2.10 to 7.56, very low certainty) and no VTE and death events. CONCLUSIONS: SA results in little to no difference in PTS, VTE and mortality in acute DVT compared to BMP. The evidence regarding SA in chronic DVT and whether SA, compared to BMP and thrombolysis, decreases PTS and VTE in acute DVT is uncertain. Open Science Framework (osf.io/f2dm6) Lippincott Williams & Wilkins 2023-06-02 /pmc/articles/PMC10237682/ /pubmed/37266612 http://dx.doi.org/10.1097/MD.0000000000033924 Text en Copyright © 2023 the Author(s). Published by Wolters Kluwer Health, Inc. https://creativecommons.org/licenses/by-nc/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC) (https://creativecommons.org/licenses/by-nc/4.0/) , where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.
spellingShingle 7100
Flumignan, Ronald Luiz Gomes
Civile, Vinicius Tassoni
Areias, Libnah Leal
Flumignan, Carolina Dutra Queiroz
Amorim, Jorge Eduardo
Lopes, Renato Delascio
Nakano, Luis C. U.
Baptista-Silva, Jose Carlos Costa
Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title_full Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title_fullStr Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title_full_unstemmed Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title_short Stenting or angioplasty for the treatment of deep vein thrombosis: Systematic review and meta-analysis of randomized controlled trials
title_sort stenting or angioplasty for the treatment of deep vein thrombosis: systematic review and meta-analysis of randomized controlled trials
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10237682/
https://www.ncbi.nlm.nih.gov/pubmed/37266612
http://dx.doi.org/10.1097/MD.0000000000033924
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