Rationale and indications for aggressive early thrombus removal

• Published in: Phlebology Vol. 27 Suppl 1; p. 78
• Main Author: Meissner, M H
• Format: Journal Article
• Language: English
• Published: England 01.03.2012
• Subjects: Anticoagulants - therapeutic use; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Mechanical Thrombolysis - adverse effects; Mechanical Thrombolysis - methods; Time Factors; Venous Thrombosis - therapy; Warfarin - therapeutic use
• ISSN: 1758-1125
• DOI: 10.1258/phleb.2012.012s11

Randomized clinical trials have defined anticoagulation with unfractionated or low-molecular-weight heparin followed by warfarin as a standard therapy for acute deep venous thrombosis (DVT). Such treatment is highly effective in preventing recurrent venous thromboembolism with a low risk of bleeding, but provides imperfect protection against development of the post-thrombotic syndrome. Several strategies of early thrombus removal, including surgical venous thrombectomy, catheter-directed thrombolysis and pharmacomechanical thrombectomy have been developed with the goal of reducing the incidence of the post-thrombotic syndrome by restoring venous patency and preserving valvular function. Although clinical judgement and a consideration of the individual patient's medical condition and values are required, early thrombus removal strategies should be considered in selected patients with phlegmasia cerulea dolens and those with a first episode of acute iliofemoral thrombosis of less than 14 days duration.