Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis

Abstract

Background The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT. Methods The clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage. Results A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) × 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) × 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (> 90%) and partial thrombolysis (50 ~ 90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions Anticoagulation therapy using low molecular-weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

Catheter-Directed Thrombolysis Protocols for Deep Venous Thrombosis of the Lower Extremities—A Systematic Review and Meta-analysis

“…The search yielded 4,168 references and 46 met the eligibility criteria for inclusion in this review 5 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 reporting 49 CDT protocols ( Fig. 1 ).…”

Machine learning-based prediction of the post-thrombotic syndrome: Model development and validation study

“…Physical pressure therapy includes the use of elastic stockings and intermittent pneumatic compression devices. The treatment plan for PCDT at our center was detailed in our previous study (22). The patients were treated with LMWH twice daily before and after PCDT.…”

Nanomicrosphere sustained-release urokinase systems with antioxidant properties for deep vein thrombosis therapy

“…Studies have shown that delivering the UK can effectively enhance the efficacy of thrombolytic therapy, making it a promising clinical application for the treatment of DVT. 27 Under normal conditions, the half-life of urokinase is usually short, about a few hours. This means that the activity of urokinase decreases rapidly over a short period of time.…”