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中华介入放射学电子杂志 ›› 2024, Vol. 12 ›› Issue (01) : 58 -63. doi: 10.3877/cma.j.issn.2095-5782.2024.01.010

基础研究

导管接触性溶栓治疗下肢深静脉血栓安全性和有效性的系统评价再评价
王勇1, 王丽2,()   
  1. 1. 210008 江苏南京,南京大学医学院附属鼓楼医院医学影像科
    2. 210008 江苏南京,南京大学医学院附属鼓楼医院介入科
  • 收稿日期:2023-02-15 出版日期:2024-02-25
  • 通信作者: 王丽
  • 基金资助:
    南京大学现代医学管理与发展研究所课题项目/南京鼓楼医院医学发展医疗救助基金会资助项目(NDYG2020034)

Safety and efficacy of catheter directed thrombolytic therapy for lower extremity deep venous thrombosis:an umbrella review

Yong Wang1, Li Wang1,()   

  1. 1. Department of Radiology, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Jiangsu Nanjing 210008, China
  • Received:2023-02-15 Published:2024-02-25
  • Corresponding author: Li Wang
引用本文:

王勇, 王丽. 导管接触性溶栓治疗下肢深静脉血栓安全性和有效性的系统评价再评价[J]. 中华介入放射学电子杂志, 2024, 12(01): 58-63.

Yong Wang, Li Wang. Safety and efficacy of catheter directed thrombolytic therapy for lower extremity deep venous thrombosis:an umbrella review[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2024, 12(01): 58-63.

目的

对下肢深静脉血栓形成患者实施导管接触性溶栓治疗的安全性和有效性进行系统评价再评价。

方法

搜索时间为建库至2021年9月。计算机检索中国知网、万方医学平台、web of science、EBSCO、Cochrane Library、PubMed、Databases@OVID平台等数据库的系统评价/Meta分析。搜索方法为中文/英文自由词和主题词的组合。使用Zotero文献管理器对检索到的文献进行去重和整理,由2名研究人员分别使用AMSTAR2和GRADE进行文献及结局指标质量评价。

结果

共纳入8篇研究类型为RCT/NRSI的系统评价,AMSTAR2评价结果显示1篇为高级质量、1篇为中级质量、3篇低级质量、3篇极低级质量。GRADE评价结果显示高级证据0条(0.00%);中级证据7条(23.33%),低级证据16条(53.33%),极低级证据7条(23.33%)。

结论

导管接触性溶栓治疗安全性相关证据涉及导管溶栓治疗灌注方式、溶栓药物使用时间和剂量。有效性指标主要为静脉通畅率和血栓后综合征发生率,但相关证据局限,文献质量不高,仍需进一步研究。

Objective

To evaluate the systematic evaluation of the safety and efficacy of catheter directed thrombolysis in patients with lower extremity deep venous thrombosis.

Methods

In September 2021, systematic reviews/meta-analyses were retrieved from CNKI, WanFang Medical Platform, Web of Science, EBSCO, Cochrane Library, PubMed, Databases@OVID and other databases. The search strategy is a combination of Chinese/English free words and subject words and the Zotero software was used to manage references. Two researchers used AMSTAR2 and GRADE respectively to evaluate the quality of literature and outcome indicators.

Results

A total of 8 RCT/NRSI systematic evaluations were included. The evaluation results of AMSTAR2 showed that 1 article was of high quality, 1 article was of intermediate quality,3 articles were of low quality and 3 articles were of extremely low quality. GRADE evaluation results showed 0 advanced evidences, accounting for 0%; 7 pieces of intermediate evidence, accounting for 23.33%,16 pieces of low-level evidence, accounting for 53.33%, and 7 pieces of extremely low-level evidence, accounting for 23.33%.

Conclusion

The infusion method, time and dose of thrombolytic drugs are the influencing factors of bleeding related safety. The main evidence of effectiveness was the rate of venous patency and the incidence of post-thrombotic syndrome. However, the relevant evidence is limited, which still needs further study.

图1 文献筛选流程图
[1]
Alesh I, Kayali F, Stein PD. Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: a systematic review[J]. Catheter Cardiovasc Interv, 2007, 70(1): 143-148.
[2]
Ng TT, Sigman M, Weaver FA. Basic data related to thrombolytic therapy for acute venous thrombosis[J]. Ann Vasc Surg, 2014, 28(4): 1039-1044.
[3]
Enden T, Haig Y, Kløw NE, et al. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial[J]. Lancet, 2012, 379(9810): 31-38.
[4]
Alhazmi L, Moustafa A, Mangi MA, et al. Efficacy and safety of catheter-directed thrombolysis in preventing post-thrombotic syndrome: a meta-analysis[J]. Cureus, 2019, 11(2): e4152.
[5]
Wang L, Zhang C, Mu S, et al. Safety of catheter-directed thrombolysis for the treatment of acute lower extremity deep vein thrombosis: a systematic review and meta-analysis[J]. Medicine (Baltimore), 2017, 96(35): e7922.
[6]
Comerota AJ, Kearon C, Gu CS, et al. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis[J]. Circulation, 2019, 139(9): 1162-1173.
[7]
Casey ET, Murad MH, Zumaeta-Garcia M, et al. Treatment of acute iliofemoral deep vein thrombosis[J]. J Vasc Surg, 2012, 55(5): 1463-1473.
[8]
Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both[J].BMJ, 2017, 358: j4008.
[9]
葛龙, 潘蓓, 潘佳雪, 等. 解读AMSTAR-2——基于随机和(或)非随机对照试验系统评价的质量评价工具[J].中国药物评价, 2017, 34(5): 334-338.
[10]
张方圆, 沈傲梅, 曾宪涛, 等. 系统评价方法学质量评价工具AMSTAR 2解读[J]. 中国循证心血管医学杂志, 2018, 10(1): 14-18.
[11]
倪萍, 时景璞. 系统评价与Meta分析再评价方法的更新及展望[J]. 中国循证心血管医学杂志, 2018, 10(10): 1170-1174.
[12]
Sterne JA, Hernan MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions[J]. BMJ, 2016, 355: i4919.
[13]
曾宪涛, 冷卫东, 李胜, 等. 如何正确理解及使用GRADE系统[J]. 中国循证医学杂志, 2011, 11(9): 985-990.
[14]
王春青, 胡雁. JBI证据预分级及证据推荐级别系统(2014版)[J]. 护士进修杂志, 2015, (11): 964-967.
[15]
Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendation[J]. BMJ, 2008, 336(7650): 924-926.
[16]
陈耀龙, 姚亮, Norris Susan, 等. GRADE在系统评价中应用的必要性及注意事项[J]. 中国循证医学杂志, 2013, 13(12): 1401-1404.
[17]
邓通, 汪洋, 王云云, 等. 临床实践指南制订方法——GRADEproGDT在干预性系统评价证据分级中的应用[J]. 中国循证心血管医学杂志, 2019, 11(1): 1-5.
[18]
Balshem H, Helfand M, Schünemann HJ, et al. GRADE guidelines: 3.Rating the quality of evidence[J]. J Clin Epidemiol, 2011, 64(4): 401-406.
[19]
朱文莉. 中医护理适宜技术干预糖尿病足的文献计量分析和系统评价再评价[D]. 合肥: 安徽中医药大学, 2020.
[20]
刘辉, 承文龙, 卢辉俊. 导管溶栓与系统溶栓治疗急性下肢深静脉血栓形成的Meta分析[J]. 中国血管外科杂志(电子版), 2016, 8(3): 183-187.
[21]
朱远志. 导管溶栓治疗早期髂股静脉血栓形成的疗效及安全性系统评价[D]. 乌鲁木齐: 新疆医科大学, 2011.
[22]
徐一丁, 胡波, 仲斌演, 等. AngioJet机械吸栓联合导管接触溶栓与单纯导管接触溶栓治疗急性下肢深静脉血栓形成的Meta分析[J]. 介入放射学杂志, 2020, 29(9): 888-893.
[23]
Farrokhi M, Khurshid M, Mohammadi S, et al. Comparison of ultrasound-accelerated versus conventional catheter-directed thrombolysis for deep vein thrombosis: a systematic review and meta-analysis[J]. Vascular, 2022, 30(2): 365-374.
[24]
Xing Z, Tang L, Zhu Z, et al. Effects of thrombolysis on outcomes of patients with deep venous thrombosis: an updated meta-analysis[J]. PLoS One, 2018, 13(9): e0204594.
[25]
Tang T, Chen L, Chen J, et al. Pharmacomechanical thrombectomy versus catheter-directed thrombolysis for iliofemoral deep vein thrombosis: a meta-analysis of clinical trials[J]. Clin Appl Thromb Hemost, 2019, 25: 1076029618821190.
[26]
Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis[J]. Cochrane Database Syst Rev, 2016, 11(11): CD002783.
[27]
Broderick C, Watson L, Armon MP. Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb[J]. Cochrane Database Syst Rev, 2021, 1(1): CD002783.
[28]
Liew A, Douketis J. Catheter-directed thrombolysis for extensive iliofemoral deep vein thrombosis: review of literature and ongoing trials[J]. Expert Rev Cardiovasc Ther, 2016, 14(2): 189-200.
[29]
Birhan A, Assefa T, Beyene A, et al. Outcome of acute deep venous thrombosis using standard treatment versus thrombolytics: a literature review[J]. Int J Hematol Oncol Stem Cell Res, 2019, 13(4): 201-207.
[30]
Elbasty A, Metcalf J. Safety and efficacy of catheter direct thrombolysis in management of acute iliofemoral deep vein thrombosis: a systematic review[J]. Vasc Specialist Int, 2017, 33(4): 121-134.
[31]
Siddiqui NA, Moosa MA, Shaikh FA, et al. Predictors of poor quality of life after primary lower limb deep venous thrombosis: a perspective from a developing nation[J]. Ann Vasc Dis, 202, 13(1): 63-68.
[32]
Hu G, Wang J. Percutaneous endovenous intervention versus anticoagulation in the treatment of lower extremity deep vein thrombosis: a systematic review and meta-analysis[J]. Ann Transl Med, 2022, 10(18): 1018.
[33]
Goldhaber SZ, Magnuson EA, Chinnakondepalli KM, et al. Catheter-directed thrombolysis for deep vein thrombosis: 2021 update[J]. Vasc Med, 2021, 26(6): 662-669.
[34]
杨克虎, 刘雅莉, 袁金秋, 等. 发展和完善中的系统评价再评价[J]. 中国循证儿科杂志, 2011, 6(1): 54-57.
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