The Outcome of Catheter-Directed Thrombolysis in COVID-19-Associated Deep Vein Thrombosis

2022 ◽  
pp. 153857442110686
Author(s):  
Manish Raval ◽  
Sunil Rajendran ◽  
Edwin Stephen
Keyword(s):  
Deep Vein Thrombosis ◽  
Laboratory Data ◽  
Case Series ◽  
Additional Risk Factor ◽  
Post Intervention ◽  
Vein Thrombosis ◽  
Published Evidence ◽  
Catheter Directed Thrombolysis ◽  
Thrombotic Complications ◽  
Deep Vein

Introduction Published evidence of venous thrombotic complications of COVID-19 is lacking from India. This case series consists of twenty-nine adult patients who were COVID -19 positive and treated for Deep Vein Thrombosis (DVT) during the second wave of the COVID-19 pandemic, in India. The study was aimed at analyzing patient demographics of patients with DVT and the outcome of Catheter-Directed Thrombolysis (CDT) in COVID positive patients. Material and Methods: Patients who developed DVT while or after being COVID positive were managed between February and April 2021 at the institution of the first two authors and were included in this retrospective study. Demographic, clinical data, laboratory data, and treatment given were analyzed. All patients were followed up for 3 months with a Villalta score. Results: There were a total of 29 patients (12 male and 17 female) included in the study with a mean age of 47 ± 17 years. The average time of presentation from being COVID positive was 17.8 ± 3.6 days and one patient developed DVT after becoming Covid negative. All but one patient had lower limb involvement, with 42.8% having proximal and 57.2% distal DVT. All patients with Iliofemoral and two with Femoropopliteal DVT were treated with catheter-di thrombolysis and the other 15 patients were managed with anticoagulation alone. No re-thrombosis was observed in the thrombolysis group. Overall average Villalta score at 3 months was 10.7 ± 2.1 with a score of 10.58 ± 2.1 in the anticoagulation-only group and 10.85 ± 2.3 in the CDT group. Conclusion: COVID-19 seems to be an additional risk factor in the development of DVT. The outcome of such patients, treated by thrombolysis appears to be similar to non-COVID patients. In this, observational experience of the authors suggests that CDT could be offered to COVID positive patients with symptomatic Iliofemoral DVT with good outcomes and an acceptable post-intervention Villalta score.

First-in-human experience of the Bashir Endovascular Catheter in the treatment of iliocaval deep vein thrombosis

2021 ◽  
pp. 1358863X2110282
Author(s):  
Mohamad Al-Otaibi ◽  
Neal B Shah ◽  
Omer Iftikhar ◽  
Prateek Sharma ◽  
Koneti Rao ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Vena Cava ◽  
Case Series ◽  
The United States ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Therapeutic Anticoagulation ◽  
Catheter Design ◽  
Deep Vein

Deep vein thrombosis (DVT) is a common disorder affecting approximately 900,000 new patients in the United States each year. Although the mainstay of treatment of DVT patients is therapeutic anticoagulation, some patients remain significantly symptomatic and therefore require more advanced interventions such as catheter-directed thrombolysis (CDT). We describe a case series of 13 patients with acute symptomatic inferior vena cava (IVC) and iliofemoral DVT that were treated with CDT using the Bashir Endovascular Catheter (BEC). We report the first-in-human use of BEC, which is a novel pharmacomechanical thrombolysis device. All the treated patients had complete and rapid resolution of their symptoms with excellent venous outflow. Despite initial promising results, larger studies using this catheter design will be needed to assess the role of BEC-directed therapy on rates of post-thrombotic syndrome and bleeding complications.

scholarly journals Catheter-directed thrombolysis for patients with acute lower extremity deep vein thrombosis: a meta-analysis

2018 ◽  
Vol 26 (0) ◽  
Author(s):  
Wang Li ◽  
Zhang Chuanlin ◽  
Mu Shaoyu ◽  
Chao Hsing Yeh ◽  
Chen Liqun ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Patency Rate ◽  
Meta Analysis ◽  
Case Series ◽  
Eligibility Criteria ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Complete Lysis ◽  
Deep Vein

ABSTRACT Objectives: To evaluate case series studies that quantitatively assess the effects of catheter-directed thrombolysis (CDT) and compare the efficacy of CDT and anticoagulation in patients with acute lower extremity deep vein thrombosis (DVT). Methods: Relevant databases, including PubMed, Embase, Cochrane, Ovid MEDLINE and Scopus, were searched through January 2017. The inclusion criteria were applied to select patients with acute lower extremity DVT treated with CDT or with anticoagulation. In the case series studies, the pooled estimates of efficacy outcomes for patency rate, complete lysis, rethrombosis and post-thrombotic syndrome (PTS) were calculated across the studies. In studies comparing CDT with anticoagulation, summary odds ratios (ORs) were calculated. Results: Twenty-five articles (six comparing CDT with anticoagulation and 19 case series) including 2254 patients met the eligibility criteria. In the case series studies, the pooled results were a patency rate of 0.87 (95% CI: 0.85-0.89), complete lysis 0.58 (95% CI: 0.40-0.75), rethrombosis 0.11 (95% CI: 0.06-0.17) and PTS 0.10 (95% CI: 0.08-0.12). Six studies comparing the efficacy outcomes of CDT and anticoagulation showed that CDT was associated with a reduction of PTS (OR 0.38, 95%CI 0.26-0.55, p<0.0001) and a higher patency rate (OR 4.76, 95%CI 2.14-10.56, p<0.0001). Conclusion: Acute lower extremity DVT patients receiving CDT were found to have a lower incidence of PTS and a higher incidence of patency rate. In our meta-analysis, CDT is shown to be an effective treatment for acute lower extremity DVT patients.

scholarly journals Posttraumatic Deep Vein Thrombosis in Collegiate Athletes: An Exploration Clinical Case Series

2018 ◽  
Vol 53 (5) ◽  
pp. 497-502 ◽  
Author(s):  
Chris Hummel ◽  
Paul R. Geisler ◽  
Tim Reynolds ◽  
Todd Lazenby
Keyword(s):  
Deep Vein Thrombosis ◽  
Clinical Case ◽  
Case Series ◽  
Collegiate Athletes ◽  
Low Risk ◽  
Long Distance ◽  
Prediction Rules ◽  
Vein Thrombosis ◽  
Published Evidence ◽  
Deep Vein

Background:  Although athletes are typically at low risk for developing venous thromboembolism (VTE), injured and noninjured athletes alike can be exposed to many acquired risk factors, including intense training, dehydration, trauma, immobilization, oral contraceptive use, and long-distance travel. Additionally, the risk of developing VTE might be increased by unidentified genetic clotting disorders. Due to the potential for fatal outcomes, knowledge of VTE pathoetiology and recognition of deep vein thrombosis (DVT) presentation should be an inherent part of the evaluation process for all who attend to athletes, regardless of age and apparent risk profile. Objective:  To present an exploration clinical case series consisting of 2 otherwise healthy, college-aged female athletes who, despite their ages and relative low risk profiles, experienced DVTs after lower extremity trauma. Each case will be discussed relative to known clinical prediction rules (CPRs) and published evidence. Conclusions:  Collectively, both cases reinforce the need for the attending clinicians to perform a thorough history and pay attention to subtle clinical findings, regardless of the relatively low risk in college-aged athletes. Although the Wells' CPRs for DVT can be used as a diagnostic guideline in the general population, it might not fully address the risks inherent in a young, otherwise healthy athletic population. We propose a risk-screening tool that is based on and modified from our experiences with these 2 patients and the known prediction rules and positive probability influences.

scholarly journals Catheter-Directed Thrombolysis in Acute Iliofemoral Deep Vein Thrombosis with or without Stenting: A Case Series

2019 ◽  
Author(s):  
Ali Mohammad Haji Zeinali ◽  
Yaser Jenab ◽  
Hamid Ariannejad ◽  
Seyed Ebrahim Kassaian ◽  
Mohammad Alidoosti ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Case Series ◽  
The Other ◽  
Residual Stenosis ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
The Common ◽  
Deep Vein

Iliofemoral deep vein thrombosis (IFDVT) is a potentially devastating condition comprising a quarter of all cases of lower extremity DVT. It can lead to serious consequences such as pulmonary embolism, limb malperfusion, and post-thrombotic syndrome (PTS), which is a chronic sequela of IFDVT. We herewith present 18 IFDVT cases managed with catheter-directed thrombolysis at our hospital. Nine of these patients underwent stenting of the involved iliac veins. The remaining 9, who did not receive stenting, had a residual stenosis of more than 50% in the common femoral or iliac veins following the procedure. Based on a final residual stenosis of less than 50% in the iliac veins, we had 9 successful (patients with stenting) and 9 unsuccessful procedures (patients without stenting). In subsequent follow-ups at a median follow-up of 39.5 months, using the Villalta score, while only 2 out of the 9 patients who underwent stenting suffered PTS, 4 patients among the other 9 patients comprising the non-stenting group developed PTS. Our results support the notion that stenting might have a role in decreasing the PTS risk in patients undergoing catheter-directed thrombolysis.  

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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