Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis.
Deep vein thromboses (DVTs) cause significant morbidity and mortality in the general population. Oral anticoagulation therapy may reduce thrombus propagation but does not cause clot lysis and therefore does not prevent postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) can be used to treat DVTs as an adjunct to medical therapy, but there is no consensus defining exact indications. Current evidence suggests that CDT can reduce clot burden and DVT recurrence and consequently prevents the formation of PTS compared with systemic anticoagulation. Appropriate indications include younger individuals with acute proximal thromboses, a long life expectancy, and relatively few comorbidities. Limb-threatening thromboses may also be treated with CDT, although the subsequent mortality remains high. A number of randomized controlled trials are currently under way comparing the longer-term outcomes of CDT compared with anticoagulation alone. Initial reports suggest that venous patency and valvular function are better maintained after CDT. The effectiveness of combined pharmacomechanical thrombectomy and the role of vena cava filters need to be investigated further before strong recommendations can be made. The reported short-term outcomes following catheter-based intervention for DVT are encouraging in selected patients. Further evidence is required to establish long-term benefits and cost-effectiveness.
St. George's Vascular Institute, St. George's Hospital NHS Trust, Blackshaw Road, London SW17 OQT, United Kingdom.
Benjamin O
BO
Patterson
Robert
R
Hinchliffe
Ian M
IM
Loftus
Matt M
MM
Thompson
Peter J E
PJ
Holt
D000208:Acute Disease; D000284:Administration, Oral; D000925:Anticoagulants / Q000008:administration & dosage; D002406:Catheterization, Peripheral; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D019317:Evidence-Based Medicine; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000191:economics; D017048:Health Care Costs; D006801:Humans; D018579:Patient Selection; D054070:Postthrombotic Syndrome / Q000209:etiology / Q000517:prevention & control; D011788:Quality of Life; D018570:Risk Assessment; D055502:Secondary Prevention; D053828:Stockings, Compression; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000191:economics; D013997:Time Factors; D016896:Treatment Outcome; D014654:Vascular Patency; D020246:Venous Thrombosis / Q000150:complications / Q000188:drug therapy* / Q000191:economics / Q000503:physiopathology; D055422:Venous Valves / Q000503:physiopathology
D000925:Anticoagulants; D005343:Fibrinolytic Agents