Thrombolysis in Deep Vein Thrombosis: Is there still an Indication?

2001 ◽  
Vol 86 (07) ◽  
pp. 499-508 ◽  
Author(s):  
Alan Forster ◽  
Philip Wells
Keyword(s):  
Thrombolytic Therapy ◽  
Meta Analysis ◽  
Local Therapy ◽  
Therapeutic Modality ◽  
Major Hemorrhage ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

SummaryThe most accepted therapy for DVT consists of anticoagulation with unfractionated heparin or low molecular weight heparin, followed by variable duration oral anticoagulation but thrombolytic therapy has been proposed in addition to standard anticoagulation. This paper reviews the literature on post thrombotic syndrome, the natural history of vein patency after therapy, and we perform a systematic review, using accepted standards for meta-analysis, to determine the outcomes when thrombolytic therapy is used to treat DVT. We demonstrate that thrombolytic therapy for DVT results in a significant increase in the risk of major hemorrhage and a significant increase in the rate of vein patency. However, although thrombolytic therapy is advantageous over anticoagulation as measured by early vein patency, a benefit in terms of a reduction in PTS risk, is unproven. Our review also shows that there is no evidence that there is a difference in efficacy between thrombolytic agents or that local therapy differs from systemic therapy. Finally, the potential role of catheter directed therapy is unknown since appropriate trials have not been performed but it is reasonable to use catheter directed therapy in patients with phlegmasia cerulea dolens. We conclude that more work is needed to define the role of thrombolytic therapy but it is too early to abandon this therapeutic modality.

Treatment Of Venous Thromboembolism - Case For Thrombolytic Therapy

1981 ◽  
Author(s):  
V V Kakkar
Keyword(s):  
Deep Vein Thrombosis ◽  
Thrombolytic Therapy ◽  
Massive Pulmonary Embolism ◽  
Vein Thrombosis ◽  
Physiological Processes ◽  
Large Numbers ◽  
Complete Lysis ◽  
Thrombus Removal ◽  
Deep Vein

Thrombolytic therapy has a unique advantage in the treatment of patients suffering from thrombotic disease, since it is capable of inducing the dissolution of intravascular fibrin and thus causing the reduction or elimination of thrombi. The rapidity of thrombus removal distinguishes this form of treatment from anticoagulant therapy, in which normal physiological processes are allowed to restore the obstructed circulation. By quickly removing the obstruction, it should be possible to reduce the mortality arising from acute thromboembolic episodes.The results of therapy for deep-vein thrombosis have been fairly uniform. The published studies can be broadly classified into two main groups; in uncontrolled trials, partial or complete lysis of thrombi was obtained in approximately 65-80% of the patients who received streptokinase, while only 10-25% of the patients receiving heparin showed this change.In patients suffering from acute major or massive pulmonary embolism, a number of trials have demonstrated a more rapid resolution of the embolus than would be expected by treatment with heparin alone.The role of lytic therapy in preventing the late sequelae of deep vein thrombosis at present remains uncertian. Studies involving large numbers of patients and longer periods of follow-up are required to determine the extent to which post phlebitic venous insufficiency is reduced by early thrombolytic therapy.

Role of Anticoagulation in Patients with Inferior Vena Cava Filter but with No Risk Factor or History of DVT/PE

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 4317-4317
Author(s):  
Mustapha A. Khalife ◽  
Vrushali S. Dabak ◽  
Marwa Hammoud ◽  
Karim Arnaout
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Ivc Filter ◽  
Vein Thrombosis ◽  
History Of ◽  
Group 2 ◽  
Deep Vein ◽  
Group 1

Abstract Abstract 4317 Introduction: Inferior Vena Cava (IVC) filters have been available for almost 40 years but their clinical utility and safety have not been completely evaluated in patients with no previous history of deep vein thrombosis (DVT) or pulmonary embolism (PE). The role of anticoagulation in patients with IVC filter with no history of DVT/PE is questionable. In this study, we try to determine if there is a role or benefit from anticoagulation in patients with an IVC filter placed but without any other risk factor for deep vein thrombosis (DVT) or pulmonary embolism (PE). Methods: we retrospectively reviewed the charts of 562 patients who had an IVC filter placed between 2003 and 2005. 442 patients were excluded because they had a history of DVT/PE, or because of a hypercoagulable state (genetic predisposition, prolonged hospitalization/immobilization, surgery, or malignancy). Of the 120 remaining patients included in this study, 6 had their IVC filter removed. And therefore we only analyzed the charts of 114 patients who had a permanent IVC filter placed for prophylactic reasons. Group 1 consisted of 17 patients who received different forms of anticoagulation (subcutaneous heparin, low molecular weight heparin or coumadin). Group 2 consisted of the remaining 97 patients who did not receive any form of anticoagulation. Results: 2 out of 17 patients in group 1 had a DVT and 14 out of 97 patients in group 2 had a DVT. The incidence of DVT was 11.8% in group 1 versus 14.4% in group 2 (p-value 0.770). The median onset of DVT/PE after IVC filter placement was 31 days. The median time of follow up was 77.33 months. Conclusion: Patients who had a permanent prophylactic IVC filter placed but with no history or risk factors for DVT/PE appear to be at an elevated risk for new DVT/PEs. In these patients, the role of anticoagulation is questionable. With a median 6 year follow up, anticoagulation seemed to non significantly lower the risk of DVT/PE. Larger randomized prospective trials are needed to examine the efficacy and duration of anticoagulation in patients with a prophylactic IVC filter placed. Disclosures: No relevant conflicts of interest to declare.

An interesting case of an atraumatic painful swollen limb in a pregnant woman

2021 ◽  
Author(s):  
Debkumar Chowdhury
Keyword(s):  
Femoral Vein ◽  
Immunoglobulin Therapy ◽  
Interesting Case ◽  
Vein Thrombosis ◽  
History Of ◽  
The Common ◽  
Bedside Ultrasonography ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens ◽  
Inpatient Basis

Phlegmasia cerulea dolens is an uncommon complication of deep venous thrombosis. This is associated with high rates of morbidity if not treated effectively. We present a young lady 13 weeks pregnant with one-day history of left lower limb swelling with pain and discolouration. Bedside ultrasonography revealed thrombosis occluding the common femoral vein and collateral femoral vein. She had history of neonatal alloimmune thrombocytopaenia (NAIT), and had immunotherapy previously. The safest option was to give low molecular weight heparin (LMWH) on an inpatient basis. Anticoagulation with LMWH has been well established as thromboprophylaxis during pregnancy, however, the safety profile of systemic anticoagulation is matter of debate. As highlighted in this scenario the management needs to be tailored on an individual basis. The cause for the extensive deep vein thrombosis could be possibly due to the recent immunoglobulin therapy, undiagnosed prothrombotic state (outwith pregnancy) or the procoagulant state associated with pregnancy.

scholarly journals Negative Pressure Wound Therapy Using Polyurethane Foam in a Patient with Necrotizing Fasciitis

2018 ◽  
Vol 55 (4) ◽  
pp. 603-605 ◽  
Author(s):  
Adelaida Avino ◽  
Cristian Radu Jecan ◽  
Cristina Nicoleta Cozma ◽  
Andra Elena Balcangiu Stroescu ◽  
Daniela Gabriela Balan ◽  
...  
Keyword(s):  
Necrotizing Fasciitis ◽  
Polyurethane Foam ◽  
Negative Pressure ◽  
Negative Pressure Wound Therapy ◽  
Skin Grafting ◽  
Wound Therapy ◽  
Vein Thrombosis ◽  
History Of ◽  
Deep Vein

Negative pressure wound therapy is one of the newest methods of treatment used in wound healing. An important role of the system has a foam dressing that connects the wound with the vacuum. In general the sponge used in vacuum assisted therapies is made of polyurethane foam. We present the case of a 51-year-old male patient with a history of deep vein thrombosis (known for about 3 years) diagnosed with necrotizing fasciitis (NF). In this patient, after each step of the surgical treatment (large debridement and skin grafting) negative pressure wound therapy using polyurethane foam was used.

Phlegmasia cerulea dolens – an uncommon but alarming manifestation of deep vein thrombosis

VASA ◽  
2020 ◽  
Vol 49 (5) ◽  
pp. 422-426
Author(s):  
Manuela Nickler ◽  
Sebastian Haubitz ◽  
Adriana Méndez ◽  
Martin Gissler ◽  
Peter Stierli ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Bleeding Risk ◽  
Venous Intervention ◽  
Aggressive Treatment ◽  
Vein Thrombosis ◽  
Prompt Treatment ◽  
Surgical Thrombectomy ◽  
Deep Vein ◽  
Phlegmasia Cerulea Dolens

Summary: In phlegmasia cerulea dolens (PCD), immediate diagnosis and prompt treatment is crucial for limb salvage. Aggressive treatment options including venous intervention, thrombolysis and/or surgical thrombectomy should be considered. Due to the lack of data, the most appropriate intervention depends upon etiology of PCD, clinical presentation and patient’s bleeding risk.

scholarly journals Exclusion of deep vein thrombosis using the Wells rule in clinically important subgroups: individual patient data meta-analysis

BMJ ◽  
2014 ◽  
Vol 348 (mar10 3) ◽  
pp. g1340-g1340 ◽  
Author(s):  
G. J. Geersing ◽  
N. P. A. Zuithoff ◽  
C. Kearon ◽  
D. R. Anderson ◽  
A. J. ten Cate-Hoek ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data ◽  
Vein Thrombosis ◽  
Wells Rule ◽  
Deep Vein
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