The Potential Role of Thrombolytic Therapy in Venous Thrombosis

Abstract

Only 15 (7%) of 209 patients with DVT exhibited no contraindications for thrombolytic treatment. Only a small fraction of patients with venous thrombosis will be potential candidates for this therapy.

Deep venous insufficiency: The relationship between lysis and subsequent reflux

“…As reported previously, only 7% of patients with an acute DVT at our institution are candidates for thrombolytic therapy. 27 Because reflux in the PTV appears to be independent of lysis time, thrombolytic therapy may have tittle role in the treatment of calf DVT. However, early lysis does appear to protect valvular integrity elsewhere.…”

Management of Venous Thromboembolism

“…[79][80][81][82][83][84] To prevent this syndrome, thrombolytic therapy has been used in patients with acute venous thrombosis in an attempt to lyse thrombi, relieve venous obstruction, and preserve venous valvular function. [84][85][86][87][88] Unfortunately, the increase in serious bleeding and the lack of evidence of efficacy limit the value of thrombolytic therapy for this indication. 86 The cornerstone of the treatment of patients with the post-thrombotic syndrome is the use of properly fitted, graduated-compression stockings.…”

“…The results of randomized trials suggest that the incidence of this syndrome is reduced if complete thrombolysis is achieved. [84][85][86][87][88] However, the substantial proportion of patients with contraindications to thrombolysis and the associated increase in major bleeding severely limit the use of thrombolytic therapy. Currently, it should be restricted to patients with extensive iliofemoral venous thrombosis (for example, phlegmasia cerulea dolens) and a low risk of bleeding.…”

Thrombolytic Therapy for Deep Venous Thrombosis?

“…[23][24][25] The major consideration was the risk of bleeding, and thrombi symptomatic for more than 7 days were considered poor candidates for lysis. 23,24 Although bleeding is still the major concern, the risk associated with a locally instilled drug appears to be less than that associated with a drug administered systemically. 3,4 This may be especially true when the drug is rtPA, whose diffusion from the thrombus is theoretically limited by its fibrin specificity.…”

“…He complained only of intermittent abdominal pain. Two days later he returned with a new complaint of left leg pain and swelling developing over the previous 24 hours. An ultrasound examination revealed extensive deep venous thrombosis (DVT) of his left lower extremity.…”