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The feasibility of catheter-directed thrombolysis for acute deep vein thrombosis: a regional perspective
B N Gauci1, J T Powell, B J Hunt
1Department of Outcome Research, St George's Vascular Institute, London SW170QT, UK.
Insights
Catheter-directed thrombolysis (CDT) may prevent post-thrombotic syndrome after deep vein thrombosis (DVT). However, only 30% of DVT patients meet current CDT eligibility criteria, limiting its widespread application.
Area of Science:
- Vascular Medicine
- Interventional Radiology
- Thrombosis Management
Background:
- Deep vein thrombosis (DVT) is a major cause of illness and death.
- Post-thrombotic syndrome (PTS) develops from DVT, causing chronic leg ulcers and reduced quality of life.
- Catheter-directed thrombolysis (CDT) may reduce PTS incidence and improve quality of life after acute proximal DVT.
Purpose of the Study:
- To determine the proportion of patients with suspected DVT who are suitable for CDT.
- To assess the potential impact of current CDT eligibility criteria on patient selection.
Main Methods:
- Retrospective review of duplex ultrasound scans for suspected upper and lower limb DVTs over one year.
- Comparison of positive scans for acute proximal lower limb DVTs against established CDT inclusion/exclusion criteria.
- Analysis of patient demographics for suitability for CDT.
Main Results:
- Out of 2368 investigations, 252 DVTs were identified, with 158 being acute proximal lower limb DVTs.
- Only 47/158 (30%) of these patients met the inclusion criteria for CDT.
- The majority of DVT patients were of working age (median age 58), with 54% being male.
Conclusions:
- Current criteria restrict CDT suitability to approximately 30% of patients with acute proximal lower limb DVT.
- This highlights a potential gap in treatment options for a significant portion of DVT patients.
- Further research may be needed to refine CDT eligibility criteria or explore alternative treatments.
Background:
Deep vein thromboses (DVTs) are a significant cause of morbidity and mortality. Valvular destruction leads to the spectrum of disease called the post-thrombotic syndrome (PTS) with the sequelae of chronic venous ulceration and a reduced quality of life. Catheter-directed thrombolysis (CDT) may reduce the incidence of PTS following an acute proximal DVT and increases quality of life thereafter, but it is uncertain what proportion of patients diagnosed with a DVT would be suitable for CDT.
Methods:
This study quantified the proportion of patients investigated for DVT that would have been suitable for CDT. A retrospective review was performed of all upper and lower limb duplex ultrasound scans for suspected DVTs in a contemporary one-year period in a major regional vascular institute. All positive scans for acute proximal lower limb DVTs were compared against strict inclusion and exclusion criteria for CDT, based on national guidelines and international randomized trials.
Results:
A total of 2368 duplex ultrasound venous investigations were performed in a one-year period and 252 scans demonstrated DVT. Of these, 158 were acute proximal lower limb DVTs. Application of the inclusion and exclusion criteria for CDT suggested that 47/158 (30%) were potentially suitable for CDT using current criteria. The median age of the 158 patients was 58 years, meaning that more than half were of working age and 54% were men.
Conclusion:
Using current eligibility criteria, only about 30% of patients with DVT appear to be suitable for CDT.
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