How to select patients with deep vein thrombosis for tPA therapy

Despite enthusiasm for using thrombolytic therapy to treat proximal deep venous thrombosis (DVT), the proportion of patients eligible for this therapeutic strategy is unknown. Therefore, we screened all patients at Brigham and Women's Hospital who underwent leg venography in 1987. Of 240 patients with suspected DVT, 87 (36%) had positive venograms. Of those with positive venograms, 72 (83%) had proximal DVT, and 15 (17%) had DVT limited to calf veins. Overall, 22% of patients with proximal DVT were eligible for thrombolytic therapy. The major exclusion criteria were: (1) recent trauma or surgery, (2) recent GI bleeding, and (3) history of a bleeding disorder. Thus, thrombolytic therapy could be given to approximately one-fifth of our patients with proximal DVT.