Indications for thrombolysis in deep venous thrombosis.
OBJECTIVE
Deep venous thromboses (DVTs) are a significant cause of morbidity and mortality in the general and inpatient population. Current anticoagulation therapy is efficient in reducing thrombus propagation but does not contribute to clot lysis or prevention of post-thrombotic limb syndrome. Catheter directed thrombolysis (CDT) is an alternative method for treating DVTs but there is no consensus regarding indications for its use.


METHODS
PubMed and Cochrane library were searched for all articles on deep vein thrombosis and thrombolysis.


METHODS
Articles presenting data on DVT thrombolysis, DVT anticoagulation, mechanical thrombectomy, venous stenting and May-Thurner's syndrome were considered for inclusion in the review.


RESULTS
CDT reduced clot burden, DVT recurrence and may prevent the formation of post-thrombotic syndrome. Indications for its use include younger individuals with a long life expectancy and few co-morbidities, limb-threatening thromboses and proximal ilio-femoral DVTs. There is a marked lack of randomised controlled trials comparing CDT-related mortality and long term outcomes compared to anticoagulation alone. The effectiveness of combined pharmaco-mechanic thrombectomy, although promising, need to be further investigated, as is the role of caval filters in preventing DVT-associated pulmonary emboli.


CONCLUSIONS
These results suggest that the outcome of CDT in DVT management are encouraging in selected patient cohorts, but further evidence is required to establish longer term benefits and cost-effectiveness.
St George's Regional Vascular Institute, 4th Floor, St James' Wing, St George's Hospital NHS Trust, Tooting, London SW17 0QT, United Kingdom.
P
P
Gogalniceanu
C J C
CJ
Johnston
U
U
Khalid
P J E
PJ
Holt
R
R
Hincliffe
I M
IM
Loftus
M M
MM
Thompson
D000925:Anticoagulants / Q000627:therapeutic use; D003362:Cost-Benefit Analysis; D005343:Fibrinolytic Agents / Q000009:adverse effects / Q000191:economics / Q000627:therapeutic use*; D006801:Humans; D018579:Patient Selection; D054070:Postthrombotic Syndrome / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D018570:Risk Assessment; D055502:Secondary Prevention; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000401:mortality
D000925:Anticoagulants; D005343:Fibrinolytic Agents