Rationale and indications for aggressive early thrombus removal.
Randomized clinical trials have defined anticoagulation with unfractionated or low-molecular-weight heparin followed by warfarin as a standard therapy for acute deep venous thrombosis (DVT). Such treatment is highly effective in preventing recurrent venous thromboembolism with a low risk of bleeding, but provides imperfect protection against development of the post-thrombotic syndrome. Several strategies of early thrombus removal, including surgical venous thrombectomy, catheter-directed thrombolysis and pharmacomechanical thrombectomy have been developed with the goal of reducing the incidence of the post-thrombotic syndrome by restoring venous patency and preserving valvular function. Although clinical judgement and a consideration of the individual patient's medical condition and values are required, early thrombus removal strategies should be considered in selected patients with phlegmasia cerulea dolens and those with a first episode of acute iliofemoral thrombosis of less than 14 days duration.
Department of Surgery, Box 356410, University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA 98195, USA. meissner@u.washington.edu
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D000925:Anticoagulants / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D061185:Mechanical Thrombolysis / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D020246:Venous Thrombosis / Q000628:therapy*; D014859:Warfarin / Q000627:therapeutic use
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight; D014859:Warfarin