Thrombolytic therapy of acute deep vein thrombosis of the lower limbs: Choices, indications and limits

1984 ◽  
Vol 14 (4) ◽  
Author(s):  
Pier Mannuccio Mannucci
Keyword(s):  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals Analysis of the Cochrane Review: Thrombolysis for Acute Deep Vein Thrombosis. Cochrane Database Syst Rev. 2014,1: CD002783.

2015 ◽  
Vol 28 (1) ◽  
pp. 12 ◽  
Author(s):  
Liliana Sousa Nanji ◽  
André Torres Cardoso ◽  
João Costa ◽  
António Vaz-Carneiro
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Bleeding Complications ◽  
Controlled Trials ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Recurrent Deep Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

<p>The standard treatment for acute deep vein thrombosis (DVT) targets to reduce immediate complications, however thrombolysis could reduce the long-term complications of post-thrombotic syndrome in the affected limb. This systematic review aimed to assess the effects of thrombolytic therapy and anticoagulation <em>versus </em>anticoagulation in people with deep vein thrombosis of the lower limb through the effects on pulmonary embolism, recurrent deep vein thrombosis, major bleeding, post-thrombotic complications, venous patency and venous function. The Cochrane Peripheral Vascular Diseases Group Trials Search Co-ordinator searched the Specialised Register (last search in April 2013) and CENTRAL (2013, Issue 4). A total of 17 randomised controlled trials (RCTs) and 1103 participants were included. In the experimental group receiving thrombolysis, complete clot lysis occurred more frequently and there was greater improvement in venous patency. The incidence of post-thrombotic syndrome decreased by a 1/3 and venous ulcers were less frequent. There were more bleeding complications and 3 strokes occurred in less recent studies, yet there seemed to be no significant effect on mortality. Data on the occurrence of pulmonary embolism and recurrent deep vein thrombosis were inconclusive. There are advantages to thrombolysis, yet the application of rigorous criteria is warranted to reduce bleeding complications. Catheter-directed thrombolysis is the current preferred method, as opposed to systemic thrombolysis in the past, and other studies comparing these procedures show that results are similar.</p><p><strong>Keywords:</strong> Randomized Controlled Trials as Topic; Thrombolytic Therapy; Venous Thrombosis.</p>

scholarly journals Prediction of Long-term Results of Conservative Treatment of Acute Deep Vein Thrombosis of Lower Limbs

2019 ◽  
Vol 58 (6) ◽  
pp. e518-e519
Author(s):  
Kirill N. Fomin ◽  
V.V. Soroka ◽  
S.P. Nohrin ◽  
A.B. Kurilov ◽  
Belousov E. Yu ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Conservative Treatment ◽  
Lower Limbs ◽  
Long Term Results ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

A Prognostic Score to Identify Low-risk Outpatients with Acute Deep Vein Thrombosis in the Lower Limbs

2015 ◽  
Vol 128 (1) ◽  
pp. 90.e9-90.e15 ◽  
Author(s):  
Javier Trujillo-Santos ◽  
Francisco Lozano ◽  
Manuel Alejandro Lorente ◽  
Dolores Adarraga ◽  
Jana Hirmerova ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Prognostic Score ◽  
Low Risk ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

scholarly journals Surviving Complications of Retroperitoneal Fibrosis with Intermittent Relapses over a Period of 20 years: Case report and literature Review

2021 ◽  
pp. 1-18
Author(s):  
Sunita Dinkar ◽  
Srajan Dashore ◽  
Sunil Joshi ◽  
Himanshu Shah ◽  
Tushar Shah
Keyword(s):  
Deep Vein Thrombosis ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Retroperitoneal Fibrosis ◽  
Vena Cava ◽  
Lower Limbs ◽  
Idiopathic Retroperitoneal Fibrosis ◽  
Vein Thrombosis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Idiopathic retroperitoneal fibrosis is a rare fibro-inflammatory disease of varied etiology which usually originates around aorta and spreads caudally along Iliac vessels into adjacent retroperitoneum causing ureteral obstruction as the most frequent complication. A 53-year-old male patient presented with complaint of mild pain in both the legs off and on. On investigating further, we found that he had been struggling with intermittent relapses every 3-4 years for last 20 years since he was first diagnosed with Idiopathic Retroperitoneal Fibrosis. He was 33-year-old when he first developed the symptoms of anuria for 48 hours and was diagnosed with Idiopathic retroperitoneal fibrosis. This was followed by atrophy of left kidney and hypertension 6 years later, then hypothyroidism after another 3years and finally involvement of Inferior Vena Cava and acute Deep Vein Thrombosis of lower limbs after another 3-4 years. His deep vein thrombosis was well managed in time. He was put on glucocorticoids everytime he had a relapse and a complication. We did a review of literature to understand recent advances about its pathogenesis, diagnosis, investigations and management. We searched in PubMed using terms like retroperitoneal fibrosis alone and in combination with related terms such as Inferior Vena Cava thrombosis, Deep Vein Thrombosis, Tamoxifen, Methotrexate. This case is unique as it is very rare to find acute Deep Vein Thrombosis in Idiopathic retroperitoneal fibrosis without development of any collaterals when Inferior Vena Cava lumen is compromised to almost complete obstruction. After a follow up of 20 years patient is doing well in terms of physical activity and psychological wellbeing with anti-hypertensives, thyroxine and anti-coagulants. Is the disease-free interval actually free of the disease or it just subsided with immunosuppressants to become active after some time?

scholarly journals Recanalization after acute deep vein thrombosis

2013 ◽  
Vol 12 (4) ◽  
pp. 296-302 ◽  
Author(s):  
Gustavo Mucoucah Sampaio Brandao ◽  
Marcone Lima Sobreira ◽  
Hamilton Almeida Rollo
Keyword(s):  
Deep Vein Thrombosis ◽  
Vessel Wall ◽  
Lower Limbs ◽  
Venous Disease ◽  
Natural Evolution ◽  
Vein Thrombosis ◽  
Complex Process ◽  
History Of ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

The process of recanalization of the veins of the lower limbs after an episode of acute deep venous thrombosis is part of the natural evolution of the remodeling of the venous thrombus in patients on anticoagulation with heparin and vitamin K inhibitors. This remodeling involves the complex process of adhesion of thrombus to the wall of the vein, the inflammatory response of the vessel wall leading to organization and subsequent contraction of the thrombus, neovascularization and spontaneous lysis of areas within the thrombus. The occurrence of spontaneous arterial flow in recanalized thrombosed veins has been described as secondary to neovascularization and is characterized by the development of flow patterns characteristic of arteriovenous fistulae that can be identified by color duplex scanning. In this review, we discuss some controversial aspects of the natural history of deep vein thrombosis to provide a better understanding of its course and its impact on venous disease.

scholarly journals Comparison of a Pocket-Sized Versus a Full-Sized Ultrasound System in the Diagnosis of Proximal Lower Limb Acute Deep Vein Thrombosis

2018 ◽  
Vol 34 (4) ◽  
pp. 245-251
Author(s):  
Hang Yee Lau ◽  
Wing Hang Luk ◽  
Dilys Choi Yu Lui ◽  
Eliza Po Yan Fung
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Lower Limbs ◽  
Vein Thrombosis ◽  
Comparable Performance ◽  
Acute Deep Vein Thrombosis ◽  
Ultrasound System ◽  
Sensitivity Specificity ◽  
Deep Vein ◽  
Proximal Lower Limb

This study assessed the performance of a pocket-sized ultrasound system for the diagnosis of proximal lower limb acute deep vein thrombosis (DVT) compared to a full-sized ultrasound system. Patients who needed urgent lower limb sonograms for acute DVT were invited for the study. In each examination, the investigator scanned the patient using the pocket-sized system and then repeated the scan using the full-sized system. The sensitivity, specificity, and accuracy of the pocket-sized system were determined in reference to the full-sized system. The venous segments that failed to be visualized using the two systems were compared. One hundred lower limbs comprising 500 venous segments were examined. There were four venous segments, including two mid and two lower femoral veins in two patients who failed to be visualized using both systems. The sensitivity, specificity, and accuracy for diagnosing proximal lower limb acute DVT were 100% (95% confidence interval [CI], 94.94%–100%), 100% (95% CI, 99.05%–100%), and 100% (95% CI, 99.19%–100%), respectively. The pocket-sized ultrasound system and the full sized-ultrasound system demonstrated a comparable performance in detecting acute DVT in the leg.

Acute Deep Vein Thrombosis Treated with Porcine Plasmin

1974 ◽  
Vol 32 (02/03) ◽  
pp. 468-482 ◽  
Author(s):  
O Storm ◽  
P Ollendorff ◽  
E Drewsen ◽  
P Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Initial Dose ◽  
Treated Group ◽  
Allergic Reactions ◽  
Double Blind ◽  
Vein Thrombosis ◽  
Thrombolytic Effect ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

SummaryThe thrombolytic effect of pig plasmin was tested in a double blind trial on patients with deep venous thrombosis in the lower limb. Only patients with not more than three days old thrombi were selected for this study. The diagnosis of deep vein thrombosis was made clinically and confirmed by phlebography. Lysofibrin Novo (porcine plasmin) or placebo (porcine plasminogen) was administered intravenously to the patients. The enzyme and the placebo were delivered as lyophilized powder in labelled bottles - the contents of the bottles were unknown to the doctor in charge of the clinical administration of the trial. An initial dose of plasmin/plasminogen of 30 unit per kg body weight given slowly intravenously (1-1% hours infusion) was followed by a maintenance dosis of 15 per cent the initial dose per hour for the following 5-7 hours. In most cases a similar maintenance dosis was given the next day. In all patients heparin was administered after ending the plasmin/plasminogen infusion. The results of the treatment was evaluated clinically as well as by control phlebo- grams the following days.A statistically significant improvement was found in the plasmin treated group compared with the placebo (plasminogen) treated group. Thrombolysis was obtained clinically and phlebographically in 65 per cent of the plasmin treated group, but only in 15 per cent of the control patients were improvements found.This study has thus demonstrated that plasmin treatment according to a standard scheme was able to induce thrombolysis. There were only a few and insignificant side effects. Allergic reactions have not been seen and only very simple tests are required.

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