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

Abstract

Background: 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) Abbreviations: BMP = best medical practice, CEAP = clinical, etiological, anatomical, and pathological elements, CENTRAL = Cochrane Central Register of Controlled Trials, CI = confidence interval, DSA = digital subtraction angiography, DVT = deep vein thrombosis, GRADE = Working Group grades of evidence, IBECS = Indice Bibliográfico Español de Ciencias de la Salud, IVC = inferior vena cava, LILACS = Latin American and Caribbean Health Science Information database, MD = mean difference, PE = pulmonary embolism, PTS = post-thrombotic syndrome, QoL = quality of life, RCTs = randomized controlled trials, RR = risk ratio, SF-36 = Medical Outcomes Study 36-Item Short Form Health Survey, SMD = standardized mean difference, VCSS = venous clinical severity score, VEINES-QoL = Venous Insufficiency Epidemiological and Economic Study-Quality of Life, VEINES-Sym = Venous Insufficiency Epidemiological and Economic Study-Symptoms, VTE = venous thromboembolism.