Rapid Thrombolysis and Preservation of Valvular Venous Function in High Deep Vein Thrombosis

Abstract

ABSTRACT. The results of streptokinase and heparin treatment are compared in a 4‐year prospective study with special reference to preservation of high valvular venous function. An objective assessment was based upon phlebographic examinations before, during and 1–2 months after therapy. Complete lysis was demonstrated in 44% of high thromboses treated with streptokinase and in 6% treated with heparin. Retrograde phlebography revealed normal function of the proximal femoral valves in 92% of streptokinase‐treated high thromboses, compared with 13% of those treated with heparin. These phlebographic results were considered to be a valid prognostic indicator of the eventual development of the postthrombotic syndrome. Allergic reactions were seen in 39% and minor haemorrhagic complications in 18% of the streptokinase‐treated cases. The therapeutic benefit of streptokinase therapy in this study was found to outweigh any disadvantages incurred by observed complications.

Antithrombotic Therapy for VTE Disease

“…Many trials of systemic thrombolysis for the treatment of DVT assessed early lysis, often reported bleeding, but rarely reported recurrent VTE or development of PTS (Table S13 and S14). [119][120][121][122][123][124][125][126][127][128][129][130][131][132][133][134][135][136][137] A meta-analysis 138 summarized the fi ndings of trials that assessed mortality, recurrent VTE, major The basis for the assumed risk (eg, the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).…”

Deep Vein Thrombosis of Lower Extremity: Direct Intraclot Injection of Alteplase Once Daily with Systemic Anticoagulation—Results of Pilot Study

“…W hile greatly reducing the risk of pulmonary embolism, treatment of deep vein thrombosis (DVT) with anticoagulation does not reliably preserve venous function of the lower extremity and results in a high rate (approximately 25%-30%) of recurrent venous thromboembolism and postthrombotic syndromes (1)(2)(3)(4)(5)(6). Results of many small studies (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) suggest that thrombolytic therapy can reduce the frequency of postthrombotic syndromes. However, because of the increased risk of bleeding, thrombolytic therapy is currently recommended for only the most severe cases of DVT (18)(19)(20)(21)(22).…”

“…Although there are many effective thrombolytic agents (7)(8)(9)(10)(36)(37)(38)(39), alteplase has two characteristics that make it preferable for intraclot treatment of DVT-its binding affinity for fibrin and its short half-life (approximately 5 minutes) in the general circulation. Because it binds to the fibrin in a thrombus, alteplase, unlike streptokinase and urokinase, does not need to be administered by continuous intraclot infusion.…”

Recurrent Venous Thromboembolism- Its Causes, Prevention and Management

“…Rapid thrombolysis and preservation of valvular venous function in high deep vein thrombosis may prevent post-thrombotic sequelae [32]. The occurrence of severe post thrombotic syndrome after primary treatment with isolated-pharmaco-mechanical thrombolysis device is low [33].…”