Recommendation ID
CG144/4
Question
Thrombolytic therapy for DVT:- What is the clinical and cost effectiveness of clot removal using catheter-directed thrombolytic therapy or pharmacomechanical thrombolysis compared with standard anticoagulation therapy for the treatment of acute proximal DVT?
Any explanatory notes
(if applicable)
Why this is important:- Clot removal strategies such as catheter-directed thrombolysis might be more effective than standard anticoagulation treatment in reducing post-thrombotic syndrome. However, there is an increased risk of major bleeding with these strategies. Evidence was identified on outcomes (mortality, major bleeding, post-thrombotic syndrome and recurrent DVT) related to clot removal strategies for the treatment of acute (less than 14 days' duration) proximal DVT. However, the studies had important methodological limitations and the follow-up periods were only 6 months. It is important to have longer-term (at least 2 years) and higher-quality evidence from RCTs to inform the decision on whether to use clot removal strategies for the treatment of acute proximal DVT. Catheter-directed or pharmacomechanical thrombolysis should be compared with standard anticoagulation therapy (LMWH or fondaparinux). The primary outcome measures should be mortality, major bleeding, VTE recurrence at 3 months, incidence and severity of post-thrombotic syndrome at 2 years (measured by a validated tool) and quality of life.

Source guidance details

Comes from guidance
Venous thromboembolic diseases: diagnosis, management and thrombophilia testing
Number
CG144
Date issued
June 2012

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No  
Last Reviewed 10/07/2012