scholarly journals Pharmacomechanical Thrombolysis in the Management of Paget-Schroetter Syndrome

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Elli Papantoniou ◽  
Luke Morgan-Rowe ◽  
Edward Johnston ◽  
Duncan Brennand ◽  
Jowad Raja ◽  
...  
Keyword(s):  
Major Haemorrhage ◽  
Postthrombotic Syndrome ◽  
Attractive Alternative ◽  
Successful Management ◽  
Rare Form ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Definitive Surgery ◽  
Clot Disruption ◽  
Subsequent Onset

Paget-Schroetter syndrome (PSS) is a rare form of thoracic outlet syndrome caused by axillosubclavian vein thrombosis which typically presents in healthy young adults. Prompt therapy, traditionally by means of catheter-directed thrombolysis (CDT) prior to definitive surgery, can prevent the subsequent onset of postthrombotic syndrome (PTS) and considerable disability. As CDT is associated with major haemorrhage and high overall treatment cost, pharmacomechanical thrombectomy (PMT) seems to be an attractive alternative which combines pharmacological thrombolysis with mechanical clot disruption. The Trellis-8 peripheral infusion catheter is an example of such a treatment which provides topical thrombolysis in an isolated zone. We describe the use of the Trellis-8 PMT system in the successful management of three patients with PSS.

scholarly journals How I treat the postthrombotic syndrome

Blood ◽  
2018 ◽  
Vol 131 (20) ◽  
pp. 2215-2222 ◽  
Author(s):  
Anat Rabinovich ◽  
Susan R. Kahn
Keyword(s):  
Risk Factors ◽  
Bleeding Risk ◽  
Secondary Prophylaxis ◽  
Postthrombotic Syndrome ◽  
Compression Stockings ◽  
Lifestyle Modifications ◽  
Vein Thrombosis ◽  
Endovascular Interventions ◽  
Catheter Directed Thrombolysis ◽  
New Information

Abstract The postthrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that imposes significant morbidity, reduces quality of life, and is costly. After DVT, 20% to 50% of patients will develop PTS, and up to 5% will develop severe PTS. The principal risk factors for PTS are anatomically extensive DVT, recurrent ipsilateral DVT, obesity, and older age. By preventing the initial DVT and DVT recurrence, primary and secondary prophylaxis of DVT will reduce occurrence of PTS. The effectiveness of elastic compression stockings (ECSs) for PTS prevention is controversial. Catheter-directed thrombolysis is not effective to prevent PTS overall but may prevent more severe forms of PTS and should be reserved for select patients with extensive thrombosis, recent symptoms onset, and low bleeding risk. For patients with established PTS, the cornerstone of management is ECS, exercise, and lifestyle modifications. Surgical or endovascular interventions may be considered in refractory cases. Because of a lack of effective therapies, new approaches to preventing and treating PTS are needed. This article uses a case-based approach to discuss risk factors for PTS after DVT, how to diagnose PTS, and available means to prevent and treat PTS, with a focus on new information in the field.

scholarly journals Catheter-Directed Thrombolysis Versus Standard Anticoagulation for Acute Lower Extremity Deep Vein Thrombosis: A Meta-Analysis of Clinical Trials

2017 ◽  
Vol 24 (7) ◽  
pp. 1134-1143 ◽  
Author(s):  
Yongming Lu ◽  
Linyi Chen ◽  
Jinhui Chen ◽  
Tao Tang
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Meta Analysis ◽  
Anticoagulation Therapy ◽  
Postthrombotic Syndrome ◽  
Bleeding Events ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Significant Difference ◽  
Deep Vein

Standard anticoagulant treatment alone for acute lower extremity deep vein thrombosis (DVT) is ineffective in eliminating thrombus from the deep venous system, with many patients developing postthrombotic syndrome (PTS). Because catheter-directed thrombolysis (CDT) can dissolve the clot, reducing the development of PTS in iliofemoral or femoropopliteal DVT. This meta-analysis compares CDT plus anticoagulation versus standard anticoagulation for acute iliofemoral or femoropopliteal DVT. Ten trials were included in the meta-analysis. Compared with anticoagulant alone, CDT was shown to significantly increase the percentage patency of the iliofemoral vein ( P < .00001; I2 = 44%) and reduce the risk of PTS ( P = .0002; I2 = 79%). In subgroup analysis of randomized controlled trials, CDT was not shown to prevent PTS ( P = .2; I2 = 59%). A reduced PTS risk was shown, however, in nonrandomized trials ( P < .00001; I2 = 47%). Meta-analysis showed that CDT can reduce severe PTS risk ( P = .002; I2 = 0%). However, CDT was not indicated to prevent mild PTS ( P = .91; I2 = 79%). A significant increase in bleeding events ( P < .00001; I2 = 33%) and pulmonary embolism (PE) ( P < .00001; I2 = 14%) were also demonstrated. However, for the CDT group, the duration of stay in the hospital was significantly prolonged compared to the anticoagulant group ( P < .00001; I2 = 0%). There was no significant difference in death ( P = .09; I2 = 0%) or recurrent venous thromboembolism events ( P = .52; I2 = 58%). This meta-analysis showed that CDT may improve patency of the iliofemoral vein or severe PTS compared with anticoagulation therapy alone, but measuring PTS risk remains controversial. However, CDT could increase the risk of bleeding events, PE events, and duration of hospital stay.

Catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of proximal deep vein thrombosis - a meta-analysis

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0195-0202 ◽  
Author(s):  
Guo-Cheng Du ◽  
Mao-Chun Zhang ◽  
Ji-Chun Zhao
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Major Bleeding ◽  
Meta Analysis ◽  
Postthrombotic Syndrome ◽  
Venous Obstruction ◽  
Vein Thrombosis ◽  
Anticoagulation Treatment ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein

Background: The aim of this meta-analysis was to compare the clinical outcomes of catheter-directed thrombolysis (CDT) plus anticoagulation with anticoagulation alone in patients with lower-extremity proximal deep vein thrombosis (DVT). Patients and methods: We systematically searched Pubmed, Embase, and the Cochrane Library from inception to October, 2014. All randomized controlled trials (RCTs) and non-randomized studies comparing the clinical outcomes between additional CDT and anticoagulation alone were included. The primary outcomes were postthrombotic syndrome and major bleeding complications. The secondary outcomes included the iliofemoral patency rate, deep venous function, mortality, pulmonary embolism, and recurrent DVT. Results: Three RCTs and 3 non-randomized studies were included. Compared with standard anticoagulation treatment, additional CDT was associated with a significantly higher rate of complete lysis within 30 days (OR = 91; 95 % CI 19.28 to 429.46), a higher rate of 6-month patency (OR = 5.77; 95 % CI 1.99 to 16.73), a lower rate of postthrombotic syndrome (OR = 0.4; 95 % CI 0.19 to 0.96), and a lower rate of venous obstruction (OR = 0.20; 95 % CI 0.09 to 0.44). More major bleeding episodes occurred in the CDT group (Peto OR 2.0; 95 % CI 1.62 to 2.62). CDT was not found to reduce mortality, pulmonary embolism, or recurrent DVT. Conclusions: Additional CDT therapy appeared to be more effective than standard anticoagulation treatment in improving the venous patency and preventing venous obstruction and postthrombotic syndrome. Caution should be taken when performing CDT given the increased risk of major bleeding. However, no evidence supported benefits of CDT in reducing mortality, recurrent DVT, or pulmonary embolism.

scholarly journals Thrombectomy and thrombolysis for the prevention and treatment of postthrombotic syndrome

Hematology ◽  
2017 ◽  
Vol 2017 (1) ◽  
pp. 681-685
Author(s):  
Suresh Vedantham
Keyword(s):  
Current Status ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Related Quality ◽  
Health Related ◽  
Significant Impairment ◽  
Individualize Treatment ◽  
Thrombus Removal ◽  
Deep Vein

Abstract Postthrombotic syndrome (PTS) is a frequent complication of lower-extremity deep vein thrombosis (DVT), occurring in approximately 40% of patients despite the use of anticoagulant therapy. PTS causes significant impairment of patients’ health-related quality of life, and no evidence-based therapies have been consistently effective. Catheter-directed thrombolysis and thrombectomy have been shown to remove acute thrombus, and it has been hypothesized they could prevent or reduce PTS. However, because these procedures can be associated with complications, mainly bleeding, randomized trial data are needed to determine when they should be used. In this article, I summarize the current status of thrombus removal procedures for DVT to provide contemporary guidance to clinicians seeking to individualize treatment decisions for their patients.

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

2017 ◽  
Vol 33 (4) ◽  
pp. 251-260 ◽  
Author(s):  
Alexander Gombert ◽  
Ricarda Gombert ◽  
Mohammad E. Barbati ◽  
Philipp Bruners ◽  
Andras Keszei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Patency Rate ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Good Patency ◽  
Deep Vein

Purpose Studies on ultrasound-accelerated, catheter-directed thrombolysis of acute deep vein thrombosis emphasize good patency rates and low complication rates. Therefore, we analyzed quality of life besides technical success and patency in our patients after ultrasound-accelerated, catheter-directed thrombolysis. Methods Between 2009 and 2014, 42 patients suffering from iliofemoral deep vein thrombosis received ultrasound-accelerated, catheter-directed thrombolysis. Follow-up included clinical exanimation and ultrasound. Thirty patients (36 interventions), mean age 41.3 years (range 19–71 years), 56.6% women (17/30), completed the surveys. Five different scores were used to assess the quality of life and symptoms of postthrombotic syndrome: SF36, Euro-QOL 5D, PDI, VEINES-QOL/Sym, and the Villalta score. Results Mean therapy duration of ultrasound-accelerated, catheter-directed thrombolysis was 76.4 h and therapeutic success could be reported in 80.5% (29/36). Successful ultrasound-accelerated, catheter-directed thrombolysis was followed by stent angioplasty in 58.3% (21/36) procedures. Overall complication rate was 19.44%, mainly formed by minor bleedings. Mean follow-up was 38.5 months. The primary patency rate was 63.8%, the assisted-primary and the secondary patency rate were 80.5%. We observed an improved quality of life in our patients’ cohort compared to patients suffering from postthrombotic syndrome. Conclusion Although ultrasound-accelerated, catheter-directed thrombolysis is feasible with good patency rates, further prospective randomized trials are necessary to evaluate the value of thrombus removal in iliofemoral deep vein thrombosis in comparison to conservative treatment.

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.

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