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.

Catheter-directed thrombolysis for deep vein thrombosis: 2021 update

2021 ◽  
pp. 1358863X2110429
Author(s):  
Samuel Z Goldhaber ◽  
Elizabeth A Magnuson ◽  
Khaja M Chinnakondepalli ◽  
David J Cohen ◽  
Suresh Vedantham
Keyword(s):  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Related Quality ◽  
Health Related ◽  
Deep Vein ◽  
Major Reduction ◽  
Selection Of Patients ◽  
Selection Of

Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.

A case-controlled study on AngioJet rheolytic thrombectomy and catheter-directed thrombolysis in the treatment of acute lower extremity deep venous thrombosis

Vascular ◽  
2019 ◽  
Vol 28 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Jun Zhu ◽  
Cai-Fang Ni ◽  
Zhen-Yu Dai ◽  
Li-Zheng Yao ◽  
Wen-Hui Li
Keyword(s):  
Deep Vein Thrombosis ◽  
Lower Extremity ◽  
Controlled Study ◽  
Efficacy And Safety ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Rheolytic Thrombectomy ◽  
Thrombus Removal ◽  
The Mean ◽  
Deep Vein

Objective This study aims to compare the efficacy and safety of AngioJet rheolytic thrombectomy vs. catheter-directed thrombolysis in patients with acute lower extremity deep vein thrombosis. Methods Between the period of February 2015 and October 2016, 65 patients with documented acute lower extremity deep vein thrombosis were treated with catheter-directed intervention. These patients were divided into two groups: AngioJet group and catheter-directed thrombolysis group. Comparisons were made with regard to efficacy and safety between these two groups. Results In the AngioJet group, complete or partial thrombus removal was accomplished in 23 (72%) and 3 (9%) patients, respectively. In the catheter-directed thrombolysis group, complete or partial thrombus removal was accomplished in 27 (82%) patients and 1 (3%) patient, respectively. In the AngioJet group, the perimeter difference between the suffered limb and healthy one declined from 5.1 ± 2.3 cm to 1.4 ± 1.2 cm ( P <  0.05). In the catheter-directed thrombolysis group, the perimeter difference declined from 4.7 ± 1.6 cm to 1.5 ± 0.9 cm ( P <  0.05). The mean urokinase dose was 0.264 ± 0.135 million units in the AngioJet group and 1.869 ± 0.528 million units in the catheter-directed thrombolysis group ( P <  0.05). The duration of thrombolysis was 4.2 ± 1.7 h in the AngioJet group and 73.6 ± 18.3 h in the catheter-directed thrombolysis group ( P <  0.05). The occurrence of complications in these two groups was 19% and 18%, respectively (not significant). Conclusion AngioJet rheolytic thrombectomy is a new, safe and effective approach for treating acute lower extremity deep vein thrombosis. When compared to catheter-directed thrombolysis, this treatment provides similar success with lower urokinase dosage and shorter duration of thrombolysis.

A Health-Related Quality of Life Measure in Patients with Deep Vein Thrombosis: A Validation Study

1999 ◽  
Vol 33 (4) ◽  
pp. 1173-1187 ◽  
Author(s):  
Susan D. Mathias ◽  
Lee Ann Prebil ◽  
Caryn G. Putterman ◽  
Joseph J. Chmiel ◽  
Richard C. Throm ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Validation Study ◽  
Health Related Quality ◽  
Life Measure ◽  
Vein Thrombosis ◽  
Related Quality ◽  
Health Related ◽  
Deep Vein

scholarly journals Health-related quality of life after deep vein thrombosis

SpringerPlus ◽  
2016 ◽  
Vol 5 (1) ◽  
Author(s):  
Kristin Kornelia Utne ◽  
Mazdak Tavoly ◽  
Hilde Skuterud Wik ◽  
Lars Petter Jelsness-Jørgensen ◽  
René Holst ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Health Related Quality ◽  
Vein Thrombosis ◽  
Related Quality ◽  
Health Related ◽  
Deep Vein

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.

scholarly journals Determinants of health-related quality of life during the 2 years following deep vein thrombosis

2008 ◽  
Vol 6 (7) ◽  
pp. 1105-1112 ◽  
Author(s):  
S. R. KAHN ◽  
H. SHBAKLO ◽  
D. L. LAMPING ◽  
C. A. HOLCROFT ◽  
I. SHRIER ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Determinants Of Health ◽  
Health Related Quality ◽  
Vein Thrombosis ◽  
Related Quality ◽  
Health Related ◽  
Deep Vein

scholarly journals Relationships between the use of pharmacomechanical catheter-directed thrombolysis, sonographic findings, and clinical outcomes in patients with acute proximal DVT: Results from the ATTRACT Multicenter Randomized Trial

2019 ◽  
Vol 24 (5) ◽  
pp. 442-451 ◽  
Author(s):  
Ido Weinberg ◽  
Suresh Vedantham ◽  
Amber Salter ◽  
Gail Hadley ◽  
Noor Al-Hammadi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Clinical Outcomes ◽  
Femoral Vein ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Thrombus Removal ◽  
Residual Thrombus ◽  
Deep Vein ◽  
To Receive

Few studies have documented relationships between endovascular therapy, duplex ultrasonography (DUS), post-thrombotic syndrome (PTS), and quality of life (QOL). The Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) trial randomized 692 patients with acute proximal deep vein thrombosis (DVT) to receive anticoagulation or anticoagulation plus pharmacomechanical catheter-directed thrombolysis (PCDT). Compression DUS was obtained at baseline, 1 month and 12 months. Reflux DUS was obtained at 12 months in a subset of 126 patients. Clinical outcomes were collected over 24 months. At 1 month, patients who received PCDT had less residual thrombus compared to Control patients, evidenced by non-compressible common femoral vein (CFV) (21% vs 35%, p < 0.0001), femoral vein (51% vs 70%, p < 0.0001), and popliteal vein (61% vs 74%, p < 0.0001). At 12 months, in the ultrasound substudy, valvular reflux prevalence was similar between groups (85% vs 91%, p = 0.35). CFV non-compressibility at 1 month was associated with higher rates of any PTS (61% vs 46%, p < 0.001), a higher incidence of moderate-or-severe PTS (30% vs 19%, p = 0.003), and worse QOL (difference 8.2 VEINES-QOL (VEnous INsufficiency Epidemiological and Economic Study on Quality of Life) points; p = 0.004) at 24 months. Valvular reflux at 12 months was associated with moderate-or-severe PTS at 24 months (30% vs 0%, p = 0.01). In summary, PCDT results in less residual thrombus but does not reduce venous valvular reflux. CFV non-compressibility at 1 month is associated with more PTS, more severe PTS, and worse QOL at 24 months. Valvular reflux may predispose to moderate-or-severe PTS. ClinicalTrials.gov Identifier NCT00790335.

Management of proximal deep vein thrombosis

2012 ◽  
Vol 27 (2_suppl) ◽  
pp. 61-72 ◽  
Author(s):  
I Nyamekye ◽  
L Merker
Keyword(s):  
Bleeding Complications ◽  
Optimal Timing ◽  
Thrombolytic Activity ◽  
Societal Costs ◽  
Percutaneous Mechanical Thrombectomy ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Specific Subgroup ◽  
Thrombus Removal ◽  
Deep Vein

Iliofemoral DVT constitutes approximately 20–25% of lower limb DVT and represents a specific subgroup of patients at highest risk for post-thrombotic syndrome (PTS). Anticoagulation alone has no significant thrombolytic activity and has not impact on PTS prevention. Early thrombus removal has reduced PTS in uncontrolled reports and reviews but major trials are awaited. The optimal timing for treatment appear to be thrombus <2 weeks old and, methods for thrombus removal include direct open or suction thrombectomy, catheter directed thrombolysis (CDT), with or without percutaneous mechanical thrombectomy (PMT) devices. Three principle types of PMT device are in use (rotational, rheolytic and ultrasound enhanced devices) and are combined with CDT in pharmocomechanical thrombolysis (PhMT) to enhance early thrombus removal. These devices have individual device specific attributes and side effects that are additional to the bleeding complications of thrombolysis. A number of additional interventions may be utilised to the improve results of CDT and PhMT. IVC filter deployment to reduce periprocedural PE, is supported by little evidence unless an indication for its use already exists. However, balloon venoplasty and vein stents undoubtedly vein patency after treatment. Early thrombus removal comes with additional upfront costs derived from devices, imaging and critical care bed usage. However, significant potential savings from reduction in PTS and rethrombosis rates may reduce overall societal costs. This review focuses on iliofemoral thrombosis, however, the less commonly encountered but clinically important subclavian vein thrombosis is also discussed.

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