title: Deep venous thrombosis associated with protein C and/or S deficiency: management with catheter-directed thrombolysis.
abstract: We performed this study to evaluate the efficacy of catheter-directed thrombolysis with urokinase in treating acute symptomatic iliofemoral deep venous thrombosis associated with protein C and/or S deficiency. A total of 42 consecutive patients with deep venous thrombosis were seen between September 2000 and August 2002. Of these, catheter-directed thrombolysis via the popliteal vein was performed in 5 patients (11.9%) with acute iliofemoral deep venous thrombosis associated with protein C and/or S deficiency. Average duration of symptoms was 4.2 days (range, 1-7 days). The average urokinase dose was 2.7 million IU (range, 0.6 million to 7.0 million IU) infused over an average of 33.1 h (range, 16-67 h). Lysis was complete in all five treated cases. Two cases had underlying iliac venous stenoses (>50%) that were treated with angioplasty and stent placement. In one patient in whom recanalization of a right iliac vein occlusion was successful, thrombosis occurred in the treated vein within 3 weeks of intervention despite full anticoagulation therapy, and further intervention was required. There were no complications or clinically detectable pulmonary emboli. The technical and clinical success rates were 100%. This initial experience suggests that catheter-directed thrombolysis for treatment of acute symptomatic iliofemoral deep venous thrombosis associated with protein C and/or S deficiency is safe and effective.
authors.affiliation: Department of Surgery and Diagnostic Radiology, Gangneung Asan Hospital, 415 Bangdong-ri, Sacheon-myeon, Gangneung, Republic of Korea.
authors.forename: Y P
authors.initials: YP
authors.lastname: Cho
authors.forename: H J
authors.initials: HJ
authors.lastname: Jang
authors.forename: D H
authors.initials: DH
authors.lastname: Lee
authors.forename: J
authors.initials: J
authors.lastname: Ahn
authors.forename: M S
authors.initials: MS
authors.lastname: Han
authors.forename: J S
authors.initials: JS
authors.lastname: Kim
authors.forename: Y H
authors.initials: YH
authors.lastname: Kim
authors.forename: S G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral; D005260:Female; D005268:Femoral Vein; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D020151:Protein C Deficiency / Q000150:complications*; D018455:Protein S Deficiency / Q000150:complications*; D015912:Thrombolytic Therapy / Q000379:methods*; D016896:Treatment Outcome; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use*; D020246:Venous Thrombosis / Q000188:drug therapy* / Q000209:etiology
chemical_list: D005343:Fibrinolytic Agents; D014568:Urokinase-Type Plasminogen Activator