Quality of life after catheter-directed thrombolysis and standard anticoagulation for iliofemoral deep-vein thrombosis

Background: Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. Catheter- directed thrombolysis (CDT) allows early removal of thrombus and reduces valvular reflux and Post-thrombotic Syndrome (PTS). Patients and methods: This prospective randomized multi-center controlled two- arm blind study was conducted in 6 centers on 252 patients with iliofemoral DVT. Patients were randomly allocated by using simple random allocation cards method into two groups; Group (A): CDT followed by oral anticoagulation (N=126 (50%)), Group (B): Standard DVT therapy (N=126 (50%)). Follow-up was for 24 months. Results: Patients of group (A) significantly complained less pain at 10 & 30 days (P-Value: 0.02 & 0.04 respectively). Also there was significant decrease in leg circumference in group (A) at 10 & 30 days (P-Value: 0.001 & 0.03 respectively). Patency of iliac vein segment was significantly higher in group (A) during the 24 months follow up (P-Value <0.001 (HS)). Patients in group (A) developed less PTS at six months, at one year and at two years (P-Value: 0.024, 0.017 and 0.035 respectively). Better Quality of life was observed in group (A) (P-Value: 0.003). Conclusion: Addition of catheter-directed thrombolysis in the treatment of acute iliofemoral DVT; was safe and tolerated by most of the patients with better effect to reduce leg pain & circumference. It was considered a protecting weapon to prevent post-thrombotic syndrome and so improve quality of life and was related to achievement of higher iliac vein patency and less reflux.

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Assessment of quality of life between patients undergoing pharmacomechanical catheter-directed thrombolysis versus conservative management with iliofemoro-popliteal deep-vein thrombosis

Indian Journal of Vascular and Endovascular Surgery ◽

10.4103/ijves.ijves_147_20 ◽

2021 ◽

Vol 8 (5) ◽

pp. 36

Author(s):

SV R Krishna Yeramsetti ◽

ShrikantPandurang Ghanwat ◽

Tapish Sahu ◽

Virender Sheorain ◽

Tarun Grover ◽

...

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Conservative Management ◽

Vein Thrombosis ◽

Catheter Directed Thrombolysis ◽

Deep Vein

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Recurrent venous thrombosis, post-thrombotic syndrome and quality of life after catheter-directed thrombolysis in severe proximal deep vein thrombosis

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2011.04298.x ◽

2011 ◽

Vol 9 (6) ◽

pp. 1261-1263 ◽

Cited By ~ 13

Author(s):

W. GHANIMA ◽

I. W. KLEVEN ◽

T. ENDEN ◽

A. ROSALES ◽

H. S. WIK ◽

...

Keyword(s):

Quality Of Life ◽

Deep Vein Thrombosis ◽

Venous Thrombosis ◽

Proximal Deep Vein Thrombosis ◽

Vein Thrombosis ◽

Post Thrombotic Syndrome ◽

Catheter Directed Thrombolysis ◽

Recurrent Venous Thrombosis ◽

Deep Vein

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

Phlebology The Journal of Venous Disease ◽

10.1177/0268355517697784 ◽

2017 ◽

Vol 33 (4) ◽

pp. 251-260 ◽

Cited By ~ 2

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.

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Catheter-directed thrombolysis for deep vein thrombosis: 2021 update

Vascular Medicine ◽

10.1177/1358863x211042930 ◽

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.

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