Local and systemic thrombolytic therapy for acute deep venous thrombosis

• Published in: Netherlands journal of medicine Vol. 63; no. 3; pp. 81 - 90
• Main Authors: JANSSEN, M. C. H, WOLLERSHEIM, H, SCHULTZE-KOOL, L. J, THIEN, Th
• Format: Journal Article
• Language: English
• Published: Alphen aan den Rijn Van zuiden 01.03.2005
• Subjects: Acute Disease; Biological and medical sciences; Catheterization, Peripheral; Fibrinolytic Agents - therapeutic use; General aspects; Humans; Medical sciences; Thrombectomy - methods; Thrombolytic Therapy - methods; Treatment Outcome; Venous Thrombosis - drug therapy; Vascular disease; Medicine; Treatment; Acute; Deep vein thrombosis; Cardiovascular disease; Fibrinolysis; Fibrinolytic; Venous disease
• ISSN: 0300-2977; 1872-9061

This article presents a review of the treatment of lower-extremity deep venous thrombosis (DVT) with systemic and catheter-directed thrombolysis (CDT) and percutaneous mechanical thrombectomy (PMT). Standard treatment including anticoagulation therapy and compression stockings may not be entirely adequate, because a significant proportion of patients eventually develop post-thrombotic syndrome (PTS). Thrombolytic agents might offer a potential advantage because they cause faster and more complete clot resolution, which may reduce or prevent residual vein stenosis and valve damage. Thrombolytic therapy results in greater lysis, but also in higher complication rates than does anticoagulation alone. Major bleeding occurs in 11% of patients treated with thrombolytic therapy. The incidence of PTS tends to be lower in patients treated with thrombolytics. However, several methodological flaws limit the conclusions with respect to reduction in PTS. No adequate randomised controlled trials have been performed comparing CDT or PMT with conventional therapy. Given the current data, thrombolytic treatment, CDT or PMT should not be applied except in extraordinary cases. First, the long-term effectiveness in terms of reducing PTS, although possible, remains uncertain. Second, the risks of thrombolytic therapy and PMT are higher. Third, current conventional therapy is relatively inexpensive, convenient and safe.