Table 35:
Summary of Findings of the Effect of Mechanical Thrombectomy in Acute DVT
| Outcome | No. of participants (studies) | Effect | GRADEa | |
|---|---|---|---|---|
| Relative (95% CI) | Absolute (95% CI) | |||
| Limb salvage | 151 (1 Obs) | OR: 2.63 (0.11-65.53) | 8 fewer per 1,000 (90 fewer to 12 more) | ⊕ Very low |
| Post- thrombotic syndrome | 386 (2 RCTs) 1,113 (8 Obs) | OR: 1.14 (0.70-1.86) OR: 0.37 (0.26-0.52) | 30 more per 1,000 (75 fewer to 149 more) 129 fewer per 1,000 (156 fewer to 95 fewer) | ⊕⊕⊕ Moderate ⊕ Very low |
| Technical success, complete thrombus removal | 478 (2 RCTs) 1,898 (15 Obs) | RR: 1.03 (0.88-1.19) RR: 1.06 (0.93-1.20) | 21 more per 1,000 (85 fewer to 135 more) 36 more per 1,000 (27 fewer to 105 more) | ⊕ Very low ⊕ Very low |
| Patency | 48 (1 RCT) | RR: 1.04 (0.93-1.17) | 38 more per 1,000 (67 fewer to 163 more) | ⊕⊕ Low |
| 683 (9 Obs) | RR: 1.10 (0.99-1.21) | 61 more per 1,000 (6 fewer to 127 more) | ⊕ Very low | |
| Re-thrombosis (and revision rates) | 232 (2 RCTs) 324 (5 Obs) | Low event rates and heterogeneity of the outcomes reported precluded pooling of findings. Overall, there were no significant findings between study groups on any metric reported | ⊕⊕ Low ⊕ Very low | |
| Pain | We did not identify any studies that reported on this outcome of interest | |||
| Quality of life | 662 (3 RCTs) | — | MD: 0.74 higher (1.67 lower to 3.14 higher) | ⊕⊕ Low |
| 95 (1 Obs) | — | MD: 1.00 higher (1.69 lower to 3.69 higher) | ⊕ Very low | |
| Perioperative mortality | 614 (2 RCTs) | OR: 1.31 (0.22-7.85) | 3 more per 1,000 (7 fewer to 57 more) | ⊕ Very Low |
| 927 (8 Obs) | There were no significant differences in mortality, with most studies reporting 0 in both study arms | ⊕ Very Low | ||
| Adverse events | 589 (3 RCTs) | There were no significant differences reported in the rates of adverse events across the different MT interventions compared to control groups | ⊕⊕⊕ Moderate | |
| (17 Obs) | There were inconsistent findings for other adverse events between study groups | ⊕ Very low | ||
| 269 (1 RCT) | — | MD: 0 (same mean volume reported in both study groups) | ⊕⊕⊕ Moderate | |
| Volume of thrombolytics (mg) | 1,226 (10 Obs) | — | SMD: 2.1 lower (3.32 lower to 0.87 lower) | ⊕ Very low |
| Time of thrombolytic infusion (hours) | 269 (1 RCT) | — | MD: 2.0 lower (3.51 lower to 0.49 lower) | ⊕⊕⊕ Moderate |
| 1,395 (10 Obs) | — | MD: 22.38 lower (29.85 lower to 14.91 lower) | ⊕ Very low | |
| Hospital length of stay (days) | 48 (1 RCT) | — | MD: 0.10 lower (0.86 lower to 0.66 higher) | ⊕⊕⊕ Moderate |
| 454 (5 Obs) | — | MD: 2.49 lower (4.44 lower to 0.53 lower) | ⊕ Very low | |
Abbreviations: CI, confidence interval; DVT, deep vein thrombosis; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; MD, mean difference; MT, mechanical thrombectomy OR, odds ratio; Obs, observational study; RCT, randomized controlled trial; RR, relative risk; SMD, standardized mean difference.
Note: summary of findings table developed using GRADEpro GDT. GRADEpro Guideline Development Tool [Software]. McMaster University and Evidence Prime, 2022. Available from gradepro.org
We evaluated the quality of the body of evidence for each outcome according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Handbook.70 See Appendix 2 for further details.