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Indications for thrombolysis in deep venous thrombosis

P Gogalniceanu1, C J C Johnston, U Khalid

  • 1St George's Regional Vascular Institute, 4th Floor, St James' Wing, St George's Hospital NHS Trust, Tooting, London SW17 0QT, United Kingdom.

European Journal of Vascular and Endovascular Surgery : the Official Journal of the European Society for Vascular Surgery
|May 12, 2009
PubMed

Insights

Catheter directed thrombolysis (CDT) shows promise in reducing deep venous thrombosis (DVT) burden and recurrence. Further research is needed to establish long-term benefits and cost-effectiveness for selected patients.

Area of Science:

  • Vascular Medicine
  • Interventional Cardiology
  • Thrombosis Management

Background:

  • Deep venous thromboses (DVTs) are a major cause of illness and death.
  • Current anticoagulation prevents clot growth but not clot dissolution or post-thrombotic syndrome.
  • Catheter directed thrombolysis (CDT) offers an alternative treatment for DVTs, but its indications are not standardized.

Purpose of the Study:

  • To review the current literature on deep venous thrombosis (DVT) and thrombolysis.
  • To evaluate the effectiveness and indications of catheter directed thrombolysis (CDT) for DVT treatment.
  • To identify gaps in the evidence regarding CDT compared to anticoagulation alone.

Main Methods:

  • Systematic literature search of PubMed and Cochrane Library for articles on DVT and thrombolysis.
  • Inclusion of studies on DVT thrombolysis, anticoagulation, mechanical thrombectomy, venous stenting, and May-Thurner's syndrome.
  • Review of data to assess outcomes, indications, and comparative effectiveness of different DVT treatments.

Main Results:

  • Catheter directed thrombolysis (CDT) demonstrated reductions in clot burden, DVT recurrence, and potential prevention of post-thrombotic syndrome.
  • Recommended indications for CDT include younger patients with good life expectancy, limb-threatening DVTs, and ilio-femoral DVTs.
  • A significant lack of randomized controlled trials exists comparing CDT outcomes to anticoagulation alone; further investigation into combined pharmaco-mechanic thrombectomy and caval filters is warranted.

Conclusions:

  • Catheter directed thrombolysis (CDT) shows encouraging outcomes in carefully selected DVT patients.
  • More evidence is required to confirm long-term benefits and cost-effectiveness of CDT.
  • Further research should focus on comparative trials and novel treatment combinations.
Abstract

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