Catheter‐Directed Thrombolysis for Prevention of Post‐Thrombotic Syndrome

2021 ◽  
Author(s):  
Brit Long ◽  
Michael Gottlieb
Keyword(s):  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis

scholarly journals Prevention of the post thrombotic syndrome with anticoagulation: a narrative review

2021 ◽  
Author(s):  
Ilia Makedonov ◽  
Susan R Kahn ◽  
Jameel Abdulrehman ◽  
Sam Schulman ◽  
Aurélien Delluc ◽  
...  
Keyword(s):  
Vitamin K Antagonists ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Economic Consequences ◽  
Compression Stockings ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Preventative Measures ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein

The post thrombotic syndrome (PTS) is chronic venous insufficiency secondary to a prior deep vein thrombosis (DVT). It is the most common complication of VTE and, while not fatal, it can lead to chronic, unremitting symptoms as well as societal and economic consequences. The cornerstone of PTS treatment lies in its prevention after DVT. Specific PTS preventative measures include the use of elastic compression stockings (ECS) and pharmacomechanical catheter directed thrombolysis (PCDT). However, the efficacy of these treatments has been questioned by large RCTs. So far, anticoagulation, primarily prescribed to prevent DVT extension and recurrence, appears to be the only unquestionably effective treatment for the prevention of PTS. In this literature review we present pathophysiological, biological, radiological and clinical data supporting the efficacy of anticoagulants to prevent PTS and the possible differential efficacy among available classes of anticoagulants (vitamin K antagonists (VKA), low molecular weight heparins (LMWHs) and direct oral anticoagulants (DOACs)). Data suggest that LMWHs and DOACs are superior to VKAs, but no head-to-head comparison is available between DOACs and LMWHs. Owing to their potentially greater anti-inflammatory properties, LMWHs could be superior to DOACs. This finding may be of interest particularly in patients with extensive DVT at high risk of moderate to severe PTS, but needs to be confirmed by a dedicated RCT.

scholarly journals Iliofemoral deep vein thrombosis and the problem of post-thrombotic syndrome

2018 ◽  
Vol 17 (2) ◽  
pp. 99-103
Author(s):  
Nicholas Denny ◽  
◽  
Shreshta Musale ◽  
Helena Edlin ◽  
Jecko Thachil ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Compression Stockings ◽  
Short Term ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Short Term Mortality ◽  
Considerable Morbidity ◽  
Deep Vein

Deep vein thrombosis (DVT) is an important cause of short-term mortality and long-term morbidity. Among the different presentations of DVT, thrombus in the iliofemoral veins may be considered the severest form. Although anticoagulation is the mainstay of the management of iliofemoral thrombosis, despite adequate anticoagulant treatment, complications including post-thrombotic syndrome is not uncommon. The latter is often overlooked but can cause considerable morbidity to the affected individuals. Preventing this condition remains a challenge but recent clinical trials of catheter directed thrombolysis and elasticated compression stockings provide some advance in this context. In this article, with the aid of a clinical case, we review the particular considerations to take into account when managing patients with an iliofemoral DVT.

scholarly journals Pharmacomechanical Catheter Directed Thrombolysis for Pregnancy Related Proximal Lower Extremity Deep Venous Thrombosis: Effectiveness in the Prevention of Post Thrombotic Syndrome

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 1448-1448
Author(s):  
Galia Spectre ◽  
Allan Bloom ◽  
Batia Roth ◽  
David Varon ◽  
Yosef Kalish ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Conflicts Of Interest ◽  
First Trimester ◽  
Control Group ◽  
Study Group ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Reduced Frequency ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein

Abstract Pharmacomechanical catheter-directed thrombolysis (PCDT) reduces the incidence of post thrombotic syndrome (PTS) after proximal deep vein thrombosis (DVT); however its efficacy in PTS prevention for pregnancy related DVT is unknown. Most of the patients with DVT in pregnancy present with femoral or iliofemoral involvement and the prevalence after of PTS after pregnancy related DVT in the lower extermity is 42%. The purpose of this study is to compare PTS outcome in women with pregnancy related DVT with and without PCDT. Methods: Women with pregnancy related proximal (femoral/iliofemoral) DVT who underwent PCDT and anticoagulation or anticoagulation alone, were evaluated for PTS using the Villalta scale and VEINES-QOL/Sym questionnaire. Results: Eleven women with iliofemoral DVT underwent PCDT and anticoagulation, two during the first trimester and nine postpartum. Eighteen women (13 with iliofemoral DVT) were treated with anticoagulation only. There was no difference in age, number of pregnancies, trimester, duration of anticoagulation or thrombophilia between the groups. The time between DVT diagnosis and study inclusion was longer in the control group - median 50.5 (range 16-120) months , compared to study group: median 27 (range 11-64) months. None of the women in the study group developed PTS. Six of 18 patients in the control group developed PTS (33.3%) P=0.03, four of whom developed severe PTS (Villalta scale ≥15). One patient in each group developed recurrent DVT, and one patient in the study group developed a calf hematoma. A reduced frequency of lower extremity symptoms was observed in the study group by VEINES-Sym questionnaire P=0.01, but there was no difference in VEINES-QOL questionnaire (p=0.11) Conclusion: This study suggests a reduction in PTS in women with pregnancy related proximal DVT who were treated with PCDT and anticoagulation compared to women who were treated with anticoagulation alone Disclosures No relevant conflicts of interest to declare.

scholarly journals Ūminės klubo ir šlaunies venų trombozės gydymo kateterizacine trombolize ir antikoaguliantais vėlyvųjų rezultatų palyginimas

2004 ◽  
Vol 2 (2) ◽  
pp. 0-0
Author(s):  
Narimantas Markevičius ◽  
Gintaras Apanavičius ◽  
Stanislovas Ščerbinskas ◽  
Marijus Gutauskas ◽  
Vytautas Triponis
Keyword(s):  
Quality Of Life ◽  
Group Treatment ◽  
Effective Means ◽  
Well Being ◽  
Long Term Results ◽  
Duplex Ultrasonography ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Working Performance

Narimantas Markevičius1, Gintaras Apanavičius1, Stanislovas Ščerbinskas2, Marijus Gutauskas1, Vytautas Triponis31 Vilniaus universiteto Kraujagyslių chirurgijos klinika,Vilniaus miesto universitetinės ligoninės I angiochirurgijos skyrius2 Vilniaus universiteto Kraujagyslių chirurgijos klinika,Vilniaus miesto universitetinės ligoninės Rentgenoangiografinių tyrimų skyrius3 Vilniaus universiteto Kraujagyslių chirurgijos klinika,Vilniaus miesto universitetinės ligoninės II angiochirurgijos skyriusAntakalnio g. 57, LT-10305 VilniusEl paštas: [email protected] Įvadas Ūminės proksimalinės giliųjų venų trombozės (GVT) vėlyvosios komplikacijos – potrombozinio sindromo – gydymas yra viena aktualiausių šiuolaikinės medicinos problemų. Taikant naujus perspektyvius gydymo metodus, galima sumažinti šio sindromo pasireiškimo dažnį. Darbe palygintas potrombozinio sindromo dažnis taikant skirtingus ūminės proksimalinės GVT gydymo metodus. Ligoniai ir metodai Vilniaus universiteto Kraujagyslių chirurgijos klinikoje nuo 1998 m. iki 2003 m. gydyta 150 ligonių, kuriems pasireiškė ūminė proksimaline GVT. 60 ligonių taikyta kateterizacinė trombolizė (I grupė), 90 ligonių gydyti tik antikoaguliantais (II grupė). Gydymo rezultatai vertinti po 1, 3, 9 ir 12 mėn. atliekant dvigubą skenavimą, po 6 mėn atliekant ascendentinę ir descendentinę venografijas. Po 16 mėn. nuo buvusios ūminės GVT atlikta visų ligonių anketinė apklausa, pateikiant jiems po 8 klausimus su sistemintais atsakymais. Buvo klausiama apie gydytų ligonių sveikatos, darbingumo, gyvenimo kokybės pokyčius po persirgtos ūminės GVT, o jei pasireiškė potrombozinis sindromas, – ar kreipėsi į gydymo įstaigas ir kiek kartų jose gydėsi. Rezultatai Atliekant dvigubą skenavimą po 12 mėn. nuo ūminės GVT, giliųjų venų vožtuvų nepakankamumas pasireiškė 10 (18%) I grupės ligonių ir 83 (93%) – II grupės. Rekanalizacijos laipsnis I grupėje siekė 99%, II grupėje – 77% Po 16 mėn. nuo persirgtos ūminės proksimalinės GVT buvo išsiųsta 150 anketų ir gauti 106 atsakymai (71%). Savo sveikatos būklę teigiamai įvertino 34 (56%) I grupės ligoniai ir 10 (11%) II grupės. Jokių kojos, kurios gilioji vena buvo užakusi, odos pokyčių nenurodė 56 (93%) I grupės ligoniai ir 23 (26%) – II grupės. Gyvenimo kokybė pablogėjo 4 (7%) I grupės ligoniams ir 42 (47%) II grupės. Darbingumą prarado 6 (10%) I grupės ligoniai ir 39 (43%) II grupės. Dėl potrombozinio sindromo į gydytojus kreipėsi 5 (5%) I grupės ligoniai ir 41 (45%) II grupės. Stacionare potrombozinis sindromas gydytas 2 (3%) I grupės ligoniams ir 40 (44%) II grupės. Išvados Kateterizacinės trombolizės taikymas ištikus ūminei proksimalinei GVT gerokai veiksmingiau apsaugo nuo potrombozinio sindromo negu gydymas tik antikoaguliantais. Tai ekonomiškai efektyvesnis metodas, kadangi vėlyvuoju laikotarpiu daug mažiau ligonių kreipiasi į gydymo įstaigas, gydosi stacionaruose. Kateterizacinė trombolizė daugumai ligonių padeda išlaikyti buvusį iki ligos darbingumą ir gyvenimo kokybę. Reikšminiai žodžiai: giliųjų venų trombozė, potrombozinis sindromas A comparison between long term results of catheter-directed thrombolysis and anticoagulation in the treatment of acute iliofemoral deep vein thrombosis Narimantas Markevičius1, Gintaras Apanavičius1, Stanislovas Ščerbinskas2, Marijus Gutauskas1, Vytautas Triponis3 Background / objective The management of remote complications of acute proximal DVT such as post-thrombotic syndrome is considered to be one of the main problems of modern medicine. The new means of the treatment of post-thrombotic syndrome can contribute to reducing the incidence of this syndrome. The incidence of post-thrombotic syndrome under different measures of DVT treatment is compared. Patients and methods A total of 150 patients with acute proximal DVT were treated at Vilnius University Clinic of Vascular Surgery from 1998 to 2003. Sixty patients were treated by catheter-directed thrombolysis (the first group) and 90 patients by anticoagulation alone (the second group). Treatment results were assessed by duplex ultrasonography at 1, 3, 9 and 12 months and by ascending and descending venography at 6 months of treatment. Following 16 months after the onset of acute DVT, 8-item questionnaires containing organized answers were administered to all the patients. The questionnaire included the assessment of health distress, working performance and the quality of life. Furthermore, this questionnaire assessed whether the patient had been referred to medical institutions due to post-thrombotic syndrome and how many times. Results Duplex ultrasonography performed 12 months after acute DVT revealed development of valvular incompetence in 18% of patients in the first group and in 93% of patients in the second group. The degree of recanalization reached 99% in the first group and 77% in the second group. Following 16 months after acute proximal DVT, 150 questionnaires were dispatched;106 (71%) patients filled in the forms. 34 (56%) patients of the first and 10 (11%) of the second group evaluated their own state of health positively. 56 (93%) patients in the first and 23 (26%) in the second group did not indicate any post-thrombotic skin changes of the affected lower extremity. Quality of life disimproved in 4 (7%) patients in the first group and in 42 (47%) patients in the second group. Working disablement was identified in 6 (10%) and 39 (43%) patients in the first and in the second groups, respectively. 5 (5%) patients in the first group and 41 (45%) in the second group consulted doctors about developing post-thrombotic syndrome. Inpatient treatment for post-thrombotic syndrome was administered to 2 (3%) patients on catheter-directed thrombolysis versus 40 (44%) patients on anticoagulation. Conclusions Catheter-directed thrombolysis for acute proximal DVT has been demonstrated to be a more effective means of post-thrombotic syndrome prophylaxis as compared with anticoagulation alone. Catheter-directed thrombolysis offered a better maintenance of working performance, the quality of life and well-being. Keywords: deep venous thrombosis, posthrombotic syndrome

Endovascular management of proximal lower limb deep venous thrombosis – A prospective study with six-month follow-up

2014 ◽  
Vol 30 (7) ◽  
pp. 441-448 ◽  
Author(s):  
S Patra ◽  
BC Srinivas ◽  
CM Nagesh ◽  
B Reddy ◽  
CN Manjunath
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Limb ◽  
Vein Thrombosis ◽  
Post Thrombotic Syndrome ◽  
Catheter Directed Thrombolysis ◽  
Grade Ii ◽  
Deep Vein ◽  
Limb Deep Vein Thrombosis ◽  
Proximal Lower Limb

Background Catheter-directed thrombolysis with assisted mechanical thrombolysis is the standard of medical care for proximal deep vein thrombosis. We studied the immediate and intermediate (six months) safety and effectiveness of catheter-directed thrombolysis in patients with proximal lower limb deep vein thrombosis. Methodology Thirty consecutive patients aged between 20 and 70 years with proximal lower limb deep vein thrombosis formed the study group. Catheter-directed thrombolysis was done with streptokinase infuse through a catheter kept in the ipsilateral popliteal vein. Unfractionated heparin was given along with streptokinase. Mechanical thromboaspiration using guiding catheter was performed in addition to thrombolytic therapy. After six months, post-thrombotic syndrome and deep venous patency were assessed by using Villalta scale and duplex ultrasound, respectively. Results Thirty patients with proximal lower limb deep vein thrombosis were treated with catheter-directed thrombolysis. Mean age of the study patients was 41.7 ± 15 years. Mean duration of illness was 13.3 ± 12 days. The mean duration of thrombolysis was 4.5 ± 1.3 days. Grade III (complete) lysis was achieved in 10 (33%) and Grade II (50–90%) lysis in 20 (67%) of patients. Patients with significant residual lesion in Grade II lysis following catheter-directed thrombolysis underwent percutaneous transluminal angioplasty alone (12/20) or venous stenting (8/20). All patients improved clinically following catheter-directed thrombolysis or assisted catheter-directed thrombolysis. Four patients (13%) developed pulmonary embolism during course of hospital stay and among them two (6.5%) patients died. Eleven patients (37%) had minor bleeding or hematoma at local site, and seven (23%) developed anemia requiring blood transfusion and four (13%) patients had thrombocytopenia. After six months, iliofemoral patency was found in 20 (72%) and post-thrombotic syndrome was seen in six (21%) patients. Two (6.5%) patients died during follow-up due to nephrotic syndrome and carcinoma breast. Conclusion Catheter-directed thrombolysis and conventional manual aspiration thrombectomy are an effective treatment for proximal lower extremity deep vein thrombosis with good short and intermediate outcome.

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