Pulse-spray pharmacomechanical thrombolysis for proximal deep vein thrombosis.
OBJECTIVE
The aim of this study was to evaluate the efficacy, safety, and feasibility of pulse-spray pharmacomechanical thrombolysis to treat proximal deep vein thrombosis (DVT) in conjunction with the placement of a non-permanent IVC filter.


METHODS
We studied 31 consecutive patients with acute proximal DVT defined as the inferior vena cava (IVC), iliac vein and/or femoral vein, who were diagnosed using duplex ultrasonography and/or contrast venography. All were treated with pulse-spray urokinase. Early success was assessed by comparing the pre- and post-treatment venographic severity score. Non-permanent IVC filters were used to reduce the risk of pulmonary thromboembolism.


RESULTS
The average total urokinase dose was 1.71 million IU (range: 0.72-3.6 million IU) and the average duration of therapy was 2.4 days. The average percentage of thrombus lysed was 85% (range: 22-100%). A large thrombus trapped by the filter was detected using cavography before extraction of the filter in one patient. There was no major treatment-related adverse event.


CONCLUSIONS
The combination of pulse-spray pharmacomechanical thrombolysis and the prophylactic use of a non-permanent IVC filter was a safe and effective approach for treating acute proximal DVT.
Yamada
N
N
First Department (Cardiovascular Division) of Internal Medicine, Mie University School of Medicine, Tsu, Mie, Japan. n-yamada@clin.medic.mie-u.ac.jp
Ishikura
K
K
Ota
S
S
Tsuji
A
A
Nakamura
M
M
Ito
M
M
Isaka
N
N
Nakano
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005268:Femoral Vein; D006801:Humans; D007084:Iliac Vein; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000517:prevention & control; D011859:Radiography; D015912:Thrombolytic Therapy / Q000379:methods; D014568:Urokinase-Type Plasminogen Activator / Q000008:administration & dosage*; D016306:Vena Cava Filters; D014682:Vena Cava, Inferior; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D014568:Urokinase-Type Plasminogen Activator