Summary.  Background: Few studies have evaluated the long‐term economic consequences of deep vein thrombosis (DVT). None of them have incorporated prospectively collected clinical data to ensure accurate identification of incident cases of DVT and DVT‐related health outcomes of interest, such as post‐thrombotic syndrome (PTS). Objectives: To prospectively quantify medical and non‐medical resource use and costs related to DVT during 2 years following diagnosis, and to identify clinical determinants of costs. Methods: Three hundred and fifty‐five consecutive patients with acute DVT were recruited at seven Canadian hospital centers. Resource use and cost information were retrieved from three sources: weekly patient‐completed cost diaries, nurse‐completed case report forms, and the Quebec provincial administrative healthcare database (RAMQ). Results: The rate of DVT‐related hospitalization was 3.5 per 100 patient‐years (95% confidence interval [CI] 2.2–4.9). Patients reported a mean (standard deviation) of 15.0 (14.5) physician visits and 0.7 (1.2) other healthcare professional visits. The average cost of DVT was $5180 (95% CI $4344–6017) in Canadian dollars, with 51.6% of costs being attributable to non‐medical resource use. Multivariate analysis identified four independent predictors of costs: concomitant pulmonary embolism (relative increase in cost [RIC] 3.16; 95% CI 2.18–4.58), unprovoked DVT (RIC 1.65; 95% CI 1.28–2.13), development of PTS during follow‐up (RIC 1.35; 95% CI 1.05–1.74), and management of DVT in the inpatient setting (RIC 1.79; 95% CI 1.33–2.40). Conclusions: The economic burden of DVT is substantial. The use of measures to prevent the occurrence of PTS and favoring outpatient care of DVT has the potential to diminish costs.

Guanella R, Ducruet T, Johri M, et al. Economic burden and cost determinants of deep vein thrombosis during 2 years following diagnosis: a prospective evaluation

OBJECTIVE
To summarize characteristics, complications and success rates of different catheter-directed thrombolysis (CDT) protocols for the treatment of lower extremities (LE) deep venous thrombosis (DVT).


METHODS
A systematic review using electronic databases (MEDLINE, Scopus and Web of Science) was performed to identify randomized controlled trials and observational studies related to LE-DVT treated with CDT. A random-effect model meta-analysis was performed to obtain the pooled proportions of early complications, post-thrombotic syndrome (PTS) and venous patency.


RESULTS
Forty-six studies met the inclusion criteria reporting 49 protocols (n=3,028 participants). In studies that addressed the thrombus location (n=37), LE-DVT had iliofemoral involvement in 90±23% of the cases. Only 4 series described CDT as the solely intervention for LE-DVT, while 47% received additional thrombectomy (manual, surgical, aspiration or pharmaco-mechanical) and 89% used stenting. Definition of venogram success was highly variable, being the Venous Registry Index the most used method (n=19). Among those, minimal thrombolysis rate (<50% lysed thrombus) was 0-53%, partial thrombolysis (50-90% lysis) was 10-71% and complete thrombolysis (90-100%) was 0-88%. Pooled outcomes were 8.7% (95%CI 6.6-10.7) for minor bleeding, 1.2% (95%CI 0.8-1.7%) for major bleeding, 1.1% (95%CI 0.6-1.6) for pulmonary embolism and 0.6% (95%CI 0.3-0.9) for death. Pooled incidences of PTS and of venous patency at up to 1 year of follow-up were 17.6% (95%CI 11.8-23.4) and 77.5% (95%CI 68.1-86.9), respectively.


CONCLUSIONS
Assessment of the evidence is hampered by the heterogeneity of protocols, which may be reflected in the variation of PTS rates. Despite this, CDT is a low-risk treatment for LE-DVT.

Catheter-directed thrombolysis protocols for deep venous thrombosis of the lower extremities - a systematic review and meta-analysis.

INTRODUCAOː O Sindrome Pos-Trombotico (SPT) e a reducao da Patencia Iliofemoral (IF) sao complicacoes comuns da Trombose Venosa Profunda Iliofemoral (TVPIF). Estudos recentes sugerem que tecnicas de tratamento endovascular, tais como a Trombolise Dirigida por Cateter (TDC) e a Trombectomia Farmacomecânica (TF), permitem reduzir de modo eficaz o risco e morbilidade de SPT em doentes com TVPIF. Este artigo visa rever a literatura atual acerca deste tema, focando-se nos outcomes obtidos a longo prazo a partir da aplicacao de tecnicas de tratamento endovascular a doentes com TVPIF. 
AQUISICAO DE EVIDENCIAː Foi elaborada uma revisao sistematica da literatura usando as bases de dados PubMed/Medline e Scopus, de acordo com as normas de publicacao da PRISMA. Um numero total de 40 artigos foram incluidos na analise qualitative da revisao, de acordo com a sua relevância cientifica. Deste grupo inicial de artigos, 9 artigos foram incluidos na realizacao da analise quantitativa.
 
SINTESE DE EVIDENCIAː O tratamento endovascular com TDC e TF esta associado a uma diminuicao do risco de desenvolvimento de SPT, por comparacao com anticoagulacao standard (OR = 0.71; 95% CI = 0.54-0.92). Para alem disso, a patencia IF apresenta taxas superiors em pacientes tratados com TDC ou TF, por comparacao com anticoagulacao standard (OR = 3.20; 95% CI = 1.80 -5.71). Nao ha diferencas estatisticas significativas no risco de SPT e na patencia IF entre pacientes tratados com TDC e TF. Complicacoes como hemorragias, embolismo pulmonar e morte tmabem nao parecem divergir entre o tratamento endovascular e anticoagulacao, bem como entre TDC e TF. 
CONCLUSOESː Tecnicas de tratamento endovascular parecem ter outcomes satisfatorios a longo prazo em doentes com TVPIF, relativamente ao risco de SPT e a preservacao da patencia IF. Contudo, investigacao adicional com ensaios clinicos randomizados prospetivos com elevado tamanho populacional e tempos de seguimento longos parece ser necessario para poderem ser tiradas mais conclusoes.

/pdf/endovascular-treatment-of-iliofemoral-deep-venous-thrombosis-22b7ik8reo.pdf

Endovascular treatment of iliofemoral deep venous thrombosis, is there enough evidence to support it? A systematic review with meta-analysis

This study evaluated whether D-dimer (DD) concentration analysis is a useful approach for noninvasive monitoring of clot lysis during catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT). DD levels have been found to be elevated during fibrinolytic therapy for DVT. Therefore, measuring the level of DD is a potential alternative method to assess the effect of fibrinolytic therapy. From January 2013 to March 2014, 32 patients with symptomatic acute DVT involving the iliac or femoral veins were treated using CDT. Urokinase was the thrombolytic agent. Demographics, procedural details, DD concentration, and thrombus score were recorded before and after the thrombolytic therapy. The peak DD concentration was 35.35 ± 11.18 μg/mL during CDT therapy, and the time-integrated DD concentration was 157.95 ± 69.46 μg·d/mL. The peak DD concentrations were higher in patients with substantial lysis compared with those in patients with minimal or no lysis (40 ± 0 versus 30.7 ± 14.57 μg/mL; P = 0.016). The ti...

Quantitation of Venous Clot Lysis With D-Dimer Assay During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

Treatment of post-stroke aphasia and its induced reorganization of language networks: a systematic review and meta-analysis study

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Quantitation of Venous Clot Lysis With D-Dimer Assay During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

Treatment of post-stroke aphasia and its induced reorganization of language networks: a systematic review and meta-analysis study