This review shows where thrombolysis in DVT truly helps and where it does not: the clearest signal is in selected iliofemoral disease, where modern catheter-based clot removal may improve patency and reduce post-thrombotic syndrome, but only at the cost of real bleeding risk. Read the full paper to see which techniques look most promising, which patients benefit most, and where the evidence still breaks down.
Abstract: The aim of this paper is to systematically review and synthesize the current evidence regarding deep venous thrombosis and its management through thrombolytic interventions, identifying key findings, clinical implications, and future research directions. The review utilises 222 original studies with 112226 total participants (topic deduplicated ΣN). Across the mapped evidence, catheter-based thrombus removal strategies show a consistent signal of improved venous patency and patient-centered outcomes in selected proximal/iliofemoral DVT, while benefits are less consistent when broader proximal segments are included and bleeding risk remains a central trade-off. In iliofemoral disease, endovascular therapy was associated with higher patency and lower PTS incidence/severity than anticoagulation alone in multiple sources, and longer-term follow-up suggests any PTS benefit may become more apparent over time. Technique evolution toward pharmacomechanical approaches and lysis-free mechanical thrombectomy is repeatedly associated with shorter treatment duration and lower thrombolytic exposure, and adjunctive iliac stenting for compressive lesions appears important for durable patency when adequate thrombus clearance is achieved. Safety signals are clinically consequential—major bleeding is a recurring concern with thrombolysis, and AngioJet-based pharmacomechanical therapy has been linked to acute kidney injury—supporting careful patient selection, complication surveillance, and consideration of lysis-sparing options where appropriate. Future research should focus on head-to-head randomized comparisons of contemporary mechanical thrombectomy and pharmacomechanical strategies (with standardized PTS and patency endpoints) and on defining which anatomic and timing-defined subgroups derive the most net clinical benefit.
Final search date and database lock: 2026-03-17 12:46:21 CET
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 2392
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 291
Included original Abstracts/Papers (Vote counting by direction of effect): 222
Reference Index (links used in paper): 114
Total participants (topic deduplicated ΣN): 112226
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Reference Index (114)
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