Meta Analysis Of The Efficacy And Safety Of Pharmacomechanical Thrombectomy And Catheter-directed Thrombolysis For The Treatment Of Lower Extremity Proximal Deep Venous Thrombosis

Objective: To systematically evaluate the efficacy and safety of pharmacomechanical thrombectomy(PMT)and catheter-directed thrombolysis(CDT)in the treatment of lower extremity proximal deep venous thrombosis.Methods: Two independent valuers used a computer to search databases such as China National Knowledge Infrastructure(CNKI),China Biomedical Abstracts(CBM),VIP(VIP),Wan fang,Pubmed,Embase,and Cochrane Library.Patients with lower extremity proximal deep venous thrombosis were selected as the research object.Valuers screened case-control studies on the efficacy and safety of PMT or CDT in the treatment of lower extremity proximal deep venous thrombosis,strictly evaluated the quality of the included studies,and extracted the data of the included studies.After the extraction,Rev Man5.3 and Stata11.0 software were used to perform Meta analysis on the data of the included literature.Results: A total of 11 studies were included,all of which were case-control studies,with a total of 637 patients.The results of this Meta analysis showed that the subsidence rate of a swelling of the affected limb in the PMT group was higher than that in the CDT group [SMD=0.65,95%CI(0.40,0.90),P<0.00001],and the difference was significant(P<0.05).There was no significant difference in the occurrence of effective thrombolysis between PMT group and CDT group [OR=1.52,95%CI(0.79,2.91)P=0.21],(P>0.05).The Villalta scale scores of the PMT group was significantly lower than that of the CDT group [SMD=-0.61,95%CI(-0.91,-0.30),P<0.0001],and the difference was significant(P<0.05).The dosage of urokinase in the PMT group was remarkably lower than that in the CDT group [MD=-160.92,95%CI(-204.58,-117.26),P<0.00001],and the difference was significant(P<0.05).The thrombolysis time in the PMT group was prominently less than CDT group [MD=-55.39,95%CI(-72.18,-38.61),P<0.00001],and the difference was significant(P<0.05).The duration of hospital stay in the PMT group was prominently shorter than CDT group [MD=-2.80,95%CI(-3.69,-1.92),P<0.00001],and the difference was significant(P<0.05).There was no evident difference in the occurrence of slight bleeding between PMT group and CDT group [OR=1.00,95%CI(0.53,1.89),P=1.00](P>0.05).Conclusion: CDT and PMT treatment have semblable thrombectomy effect and security.Compared with CDT,PMT has the advantages of faster subsidence of a swelling of the affected limb,shorter thrombolysis time,smaller dosage of urokinase,and shorter duration of hospital stay.In the future,more multicenter randomized controlled trails based on large samples are needed to compare the efficacy and safety of these two thrombolysis methods.