Thrombolytic therapy

Thrombolytic therapy may be used as either sole treatment or an adjunct to surgery in both arterial and venous disease. The age of the clot, particularly with venous thrombosis, determines the probability of successful lysis, with recent clot being highly susceptible to lytic therapy. The technique of thrombolysis is also an important determinant of the outcome, with high doses delivered directly into the clot over short time periods associated with the highest success and the lowest complication rates. Because systemic therapy increases the risk of bleeding from a remote site, techniques to concentrate the lytic agent within the clot, such as intraoperative high-dose and isolated-limb therapy, may achieve a higher success with a lower complication rate. Newer agents, which are clot specific, will be available for lytic therapy and should result in even higher success rates while minimizing systemic complications.