Feasibility Study of Catheter-directed Thrombolysis with Recombinant Staphylokinase in Deep Venous Thrombosis

1998 ◽  
Vol 79 (03) ◽  
pp. 517-519 ◽  
Author(s):  
Stephane Heymans ◽  
Raymond Verhaeghe ◽  
Luc Stockx ◽  
Désiré Collen
Keyword(s):  
Deep Vein Thrombosis ◽  
Continuous Infusion ◽  
High Speed ◽  
Minor Bleeding ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Long Term Follow Up ◽  
Valve Function ◽  
Rotating Impeller ◽  
Deep Vein

SummaryThe feasibility of catheter-directed thrombolysis with recombinant staphylokinase was evaluated in six selected patients with deep vein thrombosis. The patients underwent intrathrombus infusion of recombinant staphylokinase (2 mg bolus followed by a continuous infusion of 1 mg/h). Heparin was given via the catheter as a bolus (5000 U) and as a continuous infusion (1000 U/h). Complete lyis was obtained in five patients and partial lysis in one patient. Complications consisted of minor bleeding in four subjects. Symptomatic reocclusion occurred in one. Debulking of the thrombus mass by a high speed rotating impeller (n = 1) and stenting (n = 3) were used as additional interventions. An underlying anatomical abnormality was present in two patients. Long term follow up revealed normal patency in all patients and normal valve function in four patients. Symptomatic venous insufficiency with valve dysfunction was present in the two with a second thrombotic episode.Thus catheter-directed infusion of recombinant staphylokinase in patients with deep vein thrombosis appears feasible and may be associated with a high frequency of thrombolysis. Larger studies to define the clinical benefit of this treatment appear to be warranted.

scholarly journals Pharmacomechanical Thrombectomy Versus Catheter-Directed Thrombolysis for Iliofemoral Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

2019 ◽  
Vol 25 ◽  
pp. 107602961882119 ◽  
Author(s):  
Tao Tang ◽  
Linyi Chen ◽  
Jinhui Chen ◽  
Tong Mei ◽  
Yongming Lu
Keyword(s):  
Clinical Trials ◽  
Deep Vein Thrombosis ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Minor Bleeding ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference ◽  
Deep Vein

Early catheter-directed thrombolysis (CDT) for deep vein thrombosis (DVT) can reduce postthrombotic morbidity. Pharmacomechanical thrombolysis (PMT) is a new therapy that can be selected for the treatment of iliofemoral deep vein thrombosis (IFDVT). We performed a meta-analysis of clinical trials comparing PMT versus CDT for treatment of acute IFDVT. Literature on this topic published between January 1, 1990, and June 1, 2018, was identified using PubMed, Embase, Cochrane Library, and Web of Science. Six trials were included in the meta-analysis. Compared to CDT, PMT significantly reduced the Villalta score ( P = .007; I2 = 0%), thrombus score ( P = .01; I2 = 0%), the duration in the hospital ( P = .03; I2 = 64%), and thrombolysis time ( P < .00001, I2 = 0%). There was no significant difference in valvular incompetence events ( P = .21; I2 = 0%), minor bleeding events ( P = .59; I2 = 0%), stent events ( P = .09; I2 = 24%), and clot reduction grade I events ( P = .16; I2 = 43%) between PMT and CDT. Subgroup analysis was performed by dividing the clot reduction grade I events group into PMT plus CDT versus CDT group and significant differences were found ( P = .03, I2 = 0%) as well as for PMT alone versus CDT group ( P = .88, I2 = 37%). This meta-analysis shows that PMT reduces the severity of postthrombotic syndrome (PTS), thrombus score, duration in hospital, and thrombolysis time compared to CDT. More specifically, PMT plus CDT reduces clot reduction grade I events. No significant difference in valvular incompetence events, stent events, and minor bleeding events were found when PMT was compared to CDT.

Catheter-directed thrombolysis for deep vein thrombosis: 2021 update

2021 ◽  
pp. 1358863X2110429
Author(s):  
Samuel Z Goldhaber ◽  
Elizabeth A Magnuson ◽  
Khaja M Chinnakondepalli ◽  
David J Cohen ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Related Quality ◽  
Health Related ◽  
Deep Vein ◽  
Major Reduction ◽  
Selection Of Patients ◽  
Selection Of

Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.

Systemic inflammatory response syndrome following catheter-directed thrombolysis of acute iliofemoral deep venous thrombosis

2016 ◽  
Vol 32 (1) ◽  
pp. 61-65 ◽  
Author(s):  
J Davies ◽  
R Tippet ◽  
A Watson ◽  
J Metcalfe
Keyword(s):  
Deep Vein Thrombosis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Systemic Inflammatory Response ◽  
Good Effect ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Potential Safety ◽  
Deep Vein ◽  
Patient Concerns

Catheter-directed thrombolysis is becoming increasingly considered in the treatment of acute ileofemoral deep vein thrombosis. By targeting occlusive thrombi early, it is possible to mitigate the symptoms of post-thrombotic syndrome, which include oedema, pain, and ulceration. NICE guidelines recommend the use of catheter-directed thrombolysis in those without contraindications to treatment. The main risk of thrombolysis is bleeding; however, other side effects such as allergy have been reported. We present a 50-year-old man who presented with an acute left-sided ileofemoral deep vein thrombosis. He underwent catheter-directed thrombolysis in our centre to good effect, and ultimately he required stenting due to the presence of a May–Thurner lesion. His first day of thrombolysis, however, was complicated by a massive systemic inflammatory response syndrome response resulting in pyrexia and tachycardia, rigors, and myalgia. His deterioration in observations corresponded with a huge rise in D-dimer levels from an admission baseline of 1465 ng/ml to 182,835 ng/ml. We hypothesize that rapid breakdown of thrombus in this patient resulted in a lysis-type syndrome, presenting with a systemic inflammatory response syndrome response. Several questions are raised here including why the patient responded in this way, and whether there could be a way to predict response ahead of time? Fortunately, our patient came to no harm and continues to do well, with no evidence of further thrombosis on surveillance ultrasound. This case highlights an important complication of thrombolysis and reminds us that complications are not just limited to bleeding. Despite the short-term effects in this young fit patient, concerns must be raised about potential safety in the frailer and more elderly patient demographic in which such a large inflammatory response could be more detrimental.

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