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Role of thrombolytic therapy in axillary-subclavian vein thrombosis
A F Aburahma1, D Sadler, P Stuart
1West Virginia University Health Sciences Center, Charleston Division.
Insights
Thrombolytic therapy effectively dissolves clots in young patients with effort vein thrombosis, offering superior symptom relief compared to anticoagulation alone. Early diagnosis and treatment are crucial for better outcomes.
Area of Science:
- Vascular Medicine
- Interventional Cardiology
- Hematology
Background:
- Axillary-subclavian vein thrombosis (ASVT) in young individuals often leads to chronic disability due to poor vein recanalization.
- Effort vein thrombosis (EVT), a subset of ASVT, presents unique management challenges.
Observation:
- A review of 10 ASVT patients identified four cases of EVT.
- Diagnosis was confirmed via venography for all participants.
- Treatment modalities included urokinase, streptokinase, and conventional anticoagulation.
Findings:
- Urokinase resulted in complete clot dissolution and symptom resolution within two days in one patient.
- Streptokinase led to partial clot dissolution and symptom improvement in another patient.
- Conventional anticoagulation provided only partial symptom relief with no clot dissolution in two patients.
Implications:
- Thrombolytic therapy demonstrates superior efficacy over anticoagulation for EVT, indicated by faster symptom resolution and clot dissolution.
- Early diagnosis and prompt initiation of thrombolytic therapy are recommended for managing effort vein thrombosis.
- Further research into optimal thrombolytic strategies for ASVT is warranted to improve long-term patient prognosis.
Abstract:
Axillary-subclavian vein thrombosis in young patients has produced long-term disability because of failure of the thrombosed vein to recanalize. In a review of 10 patients with axillary-subclavian vein thrombosis treated in our institution, four were effort vein thrombosis. All patients were diagnosed by venography. One patient received urokinase with complete resolution of symptoms and complete dissolution of the clot after two days of initial therapy, which was confirmed by venography and duplex imaging. Another patient received streptokinase with partial resolution of symptoms and dissolution of the clot, which was confirmed by venography. The other two patients were treated with conventional anticoagulant therapy with partial resolution of symptoms and no dissolution of the clot. Thrombolytic therapy appears to be superior to anticoagulation in dissolution of symptoms in effort vein thrombosis and should be considered in its management if the diagnosis is made early.