Treatment Of Venous Thromboembolism - Case For Thrombolytic Therapy

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.