Thrombolytic therapy for acute deep venous thrombosis: how much is enough?
Twenty-eight patients treated with thrombolytic therapy for acute deep venous thrombosis were monitored prospectively with non-invasive testing every 12-24h during treatment to evaluate thrombus response and whether duration of therapy was appropriate. Some 75% (21 of 28) of patients demonstrated improvement with lytic therapy with 36% (10 of 28) demonstrating complete lysis; 95% of responders (20 of 21) initiated lysis within 24h. Some 33% (7 of 21) of all responders and 64% (7 of 11) of those having partial lysis had treatment terminated during thrombus resolution but before maximal lysis. Non-invasive testing indicated that thrombolytic therapy for acute deep venous thrombosis is frequently terminated before maximal lysis of the thrombus. Monitoring thrombus response with venous duplex imaging should be part of the treatment strategy of deep venous thrombosis if thrombolytic therapy is used. This approach should increase efficacy and potentially reduce complications of thrombolytic therapy for acute deep venous thrombosis.
Comerota
A J
AJ
Temple University Hospital, Department of Surgery, Philadelphia, PA 19140, USA.
Katz
M L
ML
White
J V
JV
D000208:Acute Disease; D005268:Femoral Vein; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D005342:Fibrinolysis; D005343:Fibrinolytic Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D018056:Hemorheology; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D007084:Iliac Vein; D007275:Injections, Intravenous; D008991:Monitoring, Physiologic; D010314:Partial Thromboplastin Time; D011152:Popliteal Vein; D011446:Prospective Studies; D012074:Remission Induction; D013300:Streptokinase / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013918:Thrombin Time; D015912:Thrombolytic Therapy / Q000009:adverse effects; D013924:Thrombophlebitis / Q000000981:diagnostic imaging / Q000188:drug therapy*; D013927:Thrombosis / Q000188:drug therapy; D013997:Time Factors; D018616:Ultrasonography, Doppler, Duplex; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use
D005338:Fibrin Fibrinogen Degradation Products; D005343:Fibrinolytic Agents; D005340:Fibrinogen; D013300:Streptokinase; D014568:Urokinase-Type Plasminogen Activator