Angiojet pharmacomechanical thrombectomy versus anticoagulant therapy alone in massive cancer-associated thrombosis: a single centre retrospective cohort study.

Publisher: Kluwer Academic Publishers Country of Publication: Netherlands NLM ID: 9502018 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1573-742X (Electronic) Linking ISSN: 09295305 NLM ISO Abbreviation: J Thromb Thrombolysis Subsets: MEDLINE

Original Publication: [Dordrecht ; Norwell, MA] : Kluwer Academic Publishers, c1994-

Thrombectomy*/adverse effects ; Anticoagulants*/therapeutic use ; Thrombosis*/therapy ; Neoplasms*/complications; Retrospective Studies ; Humans ; Thrombolytic Therapy/adverse effects ; Treatment Outcome

The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p > .05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p > .05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183-4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p > .05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency.
(© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Kakkos SK, Gohel M, Baekgaard N, Bauersachs R, Bellmunt-Montoya S, Black SA et al (2021) Editor’s choice-European society for vascular surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg 61:9–82. (PMID: 10.1016/j.ejvs.2020.09.02333334670)
Gussoni G, Frasson S, La Regina M, Di Micco P, Monreal, (2013) MRIET, investigators three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer findings from the RIETE registry. Thromb Res 131(01):24–30. (PMID: 10.1016/j.thromres.2012.10.00723141849)
Dhami SPS, Patmore S, O’Sullivan JM (2021) Advances in the management of cancer-associated thrombosis. Semin Thromb Hemost 47(2):139–149. (PMID: 10.1055/s-0041-172286333636745)
Blom JW, Doggen CJM, Osanto S, Rosendaal FR (2005) Malignancies, prothrombotic mutations, and the risk of venous thrombosis. JAMA 293(06):715–722. (PMID: 10.1001/jama.293.6.71515701913)
Fernandes CJ, Morinaga LTK, Alves JL Jr, Castro MA, Calderaro D, Jardim CVP et al (2019) Cancer-associated thrombosis: the when, how and why. Eur Respir Rev 28(151):180119. (PMID: 10.1183/16000617.0119-2018309180229488553)
Jiménez-Fonseca P, Gallardo E, Arranz Arija F, Blanco JM, Callejo A, Lavin DC et al (2022) Consensus on prevention and treatment of cancer-associated thrombosis (CAT) in controversial clinical situations with low levels of evidence. Eur J Intern Med 100:33–45. (PMID: 10.1016/j.ejim.2022.02.02035227541)
Key NS, Khorana AA, Kuderer NM, Bohlke K, Lee AYY, Arcelus JI et al (2020) Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 38(5):496–520. (PMID: 10.1200/JCO.19.0146131381464)
Karthikesalingam A, Young EL, Hinchliffe RJ, Loftus IM, Thompson MM, Holt PJE (2011) A systematic review of percutaneous mechanical thrombectomy in the treat-ment of deep venous thrombosis. Eur J Vasc Endovasc Surg 41:554–565. (PMID: 10.1016/j.ejvs.2011.01.01021288745)
Garcia MJ, Lookstein R, Malhotra R, Amin A, Blitz LR, Leung DA et al (2015) Endovascular management of deep vein thrombosis with rheolytic thrombectomy: final report of the prospective multicenter PEARL (Peripheral Use of AngioJet Rheolytic Thrombectomy with a Variety of Catheter Lengths) registry. J Vasc Interv Radiol 26:777–785. (PMID: 10.1016/j.jvir.2015.01.03625824314)
Vedantham S, Goldhaber SZ, Julian JA, Kahn SR, Jaff MR, Cohen DJ et al (2017) Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 377(23):2240–2252. (PMID: 10.1056/NEJMoa1615066292116715763501)
Gong M, Chen G, Zhao B, Kong J, Gu J, He X (2021) Rescue catheter-based therapies for the treatment of acute massive pulmonary embolism after unsuccessful systemic thrombolysis. J Thromb Thrombolysis 51(3):805–813. (PMID: 10.1007/s11239-020-02255-932813178)
Liu Z, Fu G, Gong M, Zhao B, Gu J, Wang T et al (2022) AngioJet rheolytic thrombectomy to treat inferior vena cava filter-related thrombosis: efficacy and safety compared with large-lumen catheter suction. Front Cardiovasc Med 21(9):837455. (PMID: 10.3389/fcvm.2022.837455)
Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH (1999) Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 211:39–49. (PMID: 10.1148/radiology.211.1.r99ap473910189452)
Bernstein SL, Bijur PE, Gallagher EJ (2006) Relationship between intensity and relief in patients with acute severe pain. Am J Emerg Med 24(2):162–166. (PMID: 10.1016/j.ajem.2005.08.00716490644)
Vedantham S, Salter A, Lancia S, Lewis L, Thukral S, Kahn SR (2021) Clinical outcomes of a pharmacomechanical catheter-directed venous thrombolysis strategy that included rheolytic thrombectomy in a multicenter randomized trial. J Vasc Interv Radiol 32(9):1296–1309. (PMID: 10.1016/j.jvir.2021.06.001341196558818274)
Vedantham S, Thorpe PE, Cardella JF, Grassi CJ, Patel NH, Ferral H, Hofmann LV, Janne d’Othée BM, Antonaci VP, Brountzos EN, Brown DB, Martin LG, Matsumoto AH, Meranze SG, Miller DL, Millward SF, Min RJ, Neithamer CD Jr, Rajan DK, Rholl KS, Schwartzberg MS, Swan TL, Towbin RB, Wiechmann BN, Sacks D (2009) Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 20(7):S227–S239. (PMID: 10.1016/j.jvir.2009.04.01619560003)
Villalta S, Bagatella P, Piccioli A, Lensing A, Prins M, Prandoni P (1994) Assessment of validity and reproducibility of a clinical scale for the post-thrombotic syndrome. Haemostasis 24:158a.
Kakkar AK, Levine MN, Kadziola Z et al (2004) Low molecular weight heparin, therapy with dalteparin, and survival in advanced cancer: the fragmin advanced malignancy outcome study (FAMOUS). J Clin Oncol 22(10):1944–1948. (PMID: 10.1200/JCO.2004.10.00215143088)
Sørensen HT, Mellemkjaer L, Olsen JH, Baron JA (2000) Prognosis of cancers associated with venous thromboembolism. N Engl J Med 343(25):1846–1850. (PMID: 10.1056/NEJM20001221343250411117976)
Prandoni P, Lensing AW, Piccioli A et al (2002) Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100(10):3484–3488. (PMID: 10.1182/blood-2002-01-010812393647)
Ni Q, Long J, Guo X, Yang S, Meng X, Zhang L, Fang X, Ye M (2021) Clinical efficacy of one-stage thrombus removal via contralateral femoral and ipsilateral tibial venous access for pharmacomechanical thrombectomy in entire-limb acute deep vein thrombosis: a retrospective cohort study. J Vasc Surg Venous Lymphat Disord 9(5):1128–1135. (PMID: 10.1016/j.jvsv.2021.01.00733540135)
Gong M, Zhao B, He X, Gu J, Chen G (2019) Feasibility of low-dose infusion of alteplase for unsuccessful thrombolysis with urokinase in deep venous thrombosis. Exp Ther Med 18:3667–3674. (PMID: 316022456777307)
Broderick C, Watson L, Armon MP (2021) Thrombolytic strategies versus standard anticoagulation for acute deep vein thrombosis of the lower limb. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD002783.pub5. (PMID: 10.1002/14651858.CD002783.pub5347866928595079)
Lee SH, Kim HK, Hwang JK, Kim SD, Park SC, Kim JI et al (2016) Efficacy of retrievable inferior vena cava filter placement in the prevention of pulmonary embolism during catheter-directed thrombectomy for proximal lower-extremity deep vein thrombosis. Ann Vasc Surg 33:181–186. (PMID: 10.1016/j.avsg.2015.10.03426806235)
Gussoni G, Frasson S, La Regina M, Di Micco P, Monreal. (2013) Three-month mortality rate and clinical predictors in patients with venous thromboembolism and cancer Findings from the RIETE registry. Thromb Res 131(1):24–30. (PMID: 10.1016/j.thromres.2012.10.00723141849)

8187 1463 National Natural Science Foundation of China

Keywords: Anticoagulant treatment; Cancer-associated thrombosis; Catheter-directed thrombolysis; Percutaneous mechanical thrombectomy; Prognosis

0 (Anticoagulants)

Date Created: 20230111 Date Completed: 20231128 Latest Revision: 20231128

20231215

10.1007/s11239-023-02770-5

36630028