Correspondence

Dear Sir, In the latest edition of the journal, catheter-directed thrombolysis was reviewed (1), and does appear to be an attractive therapeutic option for treatment of deep venous thrombosis, both in prevention of postthrombotic syndrome and avoidance of anticoagulant therapy. I have one concern about the procedure with regards to the quoted bleeding rates. A systematic review reported high bleeding rates at 31% though major bleeding rates were low (2)

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Risk factors of postthrombotic syndrome before and after deep venous thrombosis treatment

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516652010 ◽

2016 ◽

Vol 32 (6) ◽

pp. 384-389 ◽

Cited By ~ 4

Author(s):

Rob HW Strijkers ◽

Mark AF de Wolf ◽

Cees HA Wittens

Keyword(s):

Risk Factors ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Treatment Options ◽

Postthrombotic Syndrome ◽

Factor X ◽

Catheter Directed Thrombolysis ◽

Before And After ◽

Patient Selection Criteria ◽

The Moment

Postthrombotic syndrome is the most common complication after deep venous thrombosis. Postthrombotic syndrome is a debilitating disease and associated with decreased quality of life and high healthcare costs. Postthrombotic syndrome is a chronic disease, and causative treatment options are limited. Prevention of postthrombotic syndrome is therefore very important. Not all patients develop postthrombotic syndrome. Risk factors have been identified to try to predict the risk of developing postthrombotic syndrome. Age, gender, and recurrent deep venous thrombosis are factors that cannot be changed. Deep venous thrombosis location and extent seem to predict severity of postthrombotic syndrome and are potentially suitable as patient selection criteria. Residual thrombosis and reflux are known to increase the incidence of postthrombotic syndrome, but are of limited use. More recently developed treatment options for deep venous thrombosis, such as new oral factor X inhibitors and catheter-directed thrombolysis, are available at the moment. Catheter-directed thrombolysis shows promising results in reducing the incidence of postthrombotic syndrome after deep venous thrombosis. The role of new oral factor X inhibitors in preventing postthrombotic syndrome is still to be determined.

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Catheter-directed thrombolysis (intrathrombus injection) in treatment of deep venous thrombosis: A systematic review

Catheterization and Cardiovascular Interventions ◽

10.1002/ccd.21079 ◽

2007 ◽

Vol 70 (1) ◽

pp. 145-150 ◽

Cited By ~ 42

Author(s):

Issa Alesh ◽

Fadi Kayali ◽

Paul D. Stein

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Catheter Directed Thrombolysis

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Anticoagulation alone versus combined catheter-directed thrombolysis and anticoagulation in treatment of acute ilio-femoral deep venous thrombosis

International Surgery Journal ◽

10.18203/2349-2902.isj20193310 ◽

2019 ◽

Vol 6 (8) ◽

pp. 2698

Author(s):

Mostafa A. Elaggory ◽

Mahmoud S. Eldesouky ◽

Nehad A. Zeid

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Anticoagulant Therapy ◽

Venous Insufficiency ◽

Absolute Risk ◽

Duplex Ultrasound ◽

Absolute Risk Reduction ◽

Controlled Study ◽

Compression Stocking ◽

Catheter Directed Thrombolysis

Background: It was found that 50% of patients with iliofemoral deep venous thrombosis (DVT) treated by anticoagulant alone and compression stocking developed post thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase venous patency and prevent PTS. The objective of the study was to assess short-term efficacy of additional catheter directed thrombolysis (CDT) compared with standard anticoagulant therapy alone.Methods: Prospective, randomized, controlled study on 50 patients (18–75 years) with acute iliofemoral DVT and symptoms <21 days were randomized to receive additional CDT or standard anticoagulant therapy alone. After 6 months, vein patency and insufficiency (reflux) was assessed using duplex ultrasound by an investigator blinded to previous treatments.Results: Fifty patients were allocated additional CDT (n=25) or ACs alone (n=25). After CDT, grade III (complete) lysis was achieved in 17 (68%) and grade II (50%–90%) lysis in 5 patients (20%). One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 17 (68%) in the CDT group vs. 8 (32%) controls, corresponding to an absolute risk reduction 36% (95% CI, p=0.002). Femoral venous insufficiency was found to be higher among the ACs group 11 patients (44%) vs. 7 patients (28%) in the CDT group.Conclusions: After 6 months, additional CDT increased iliofemoral patency from 32% to 68% and decreased venous insufficiency from 44% to 28%.

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A systematic review of paediatric deep venous thrombolysis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518778660 ◽

2018 ◽

Vol 34 (3) ◽

pp. 179-190 ◽

Cited By ~ 1

Author(s):

Mohamed AH Taha ◽

Andrew Busuttil ◽

Roshan Bootun ◽

Alun H Davies

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Therapeutic Option ◽

Incidence Rates ◽

Systemic Thrombolysis ◽

Post Thrombotic Syndrome ◽

Catheter Directed Thrombolysis ◽

Significant Difference ◽

One Year ◽

Abstract Screening

Objectives The aim was to assess the effectiveness and safety of catheter-directed thrombolysis in children with deep venous thrombosis and to evaluate its long-term effect. Method and results EMBASE, Medline and Cochrane databases were searched to identify studies in which paediatric acute deep venous thrombosis patients received thrombolysis. Following title and abstract screening, seven cohort studies with a total of 183 patients were identified. Technical success was 82% and superior in regional rather than systemic thrombolysis (p < 0.00001). One cohort study identified significant difference in thrombus resolution at one year between thrombolytic and anticoagulant groups (p = 0.01). The complication rate was low, with incidence rates of major bleeding, pulmonary embolism and others at 2.8%, 1.8% and 8.4%, respectively. The overall post-thrombotic syndrome rate was 12.7%. The incidence of re-thrombosis ranged from 12.3% to 27%. Conclusion Thrombolysis for paediatric deep venous thrombosis is an effective and relatively safe therapeutic option, lowering the incidence of post-thrombotic syndrome and deep venous thrombosis recurrence.

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Efficacy of compression stockings in preventing post-thrombotic syndrome in patients with deep venous thrombosis: a systematic review and metaanalysis

VASA ◽

10.1024/0301-1526/a000508 ◽

2016 ◽

Vol 45 (2) ◽

pp. 141-147 ◽

Cited By ~ 7

Author(s):

Jakob Martin Burgstaller ◽

Johann Steurer ◽

Ulrike Held ◽

Beatrice Amann-Vesti

Keyword(s):

Systematic Review ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Cochrane Library ◽

Compression Stockings ◽

Post Thrombotic Syndrome ◽

Study Results ◽

Preventive Efficacy ◽

One Year ◽

The Cochrane Library

Abstract. Background: Here, we update an earlier systematic review on the preventive efficacy of active compression stockings in patients with diagnosed proximal deep venous thrombosis (DVT) by including the results of recently published trials. The aims are to synthesize the results of the original studies, and to identify details to explain heterogeneous results. Methods: We searched the Cochrane Library, PubMed, Scopus, and Medline for original studies that compared the preventive efficacy of active compression stockings with placebo or no compression stockings in patients with diagnosed proximal DVT. Only randomized controlled trials (RCTs) were included. Results: Five eligible RCTs with a total of 1393 patients (sample sizes ranged from 47 to 803 patients) were included. In three RCTs, patients started to wear compression stockings, placebo stockings or no stockings within the first three weeks after the diagnosis of DVT. The results of two RCTs indicate a statistically significant reduction in post-thrombotic syndrome (PTS) of 50% or more after two or more years. The result of one RCT shows no preventive effect of compression stockings at all. Due to the heterogeneity of the study results, we refrained from pooling the results of the RCTs. In a further RCT, randomization to groups with and without compression stockings took place six months after the diagnosis of DVT, and in another RCT, only patients with the absence of PTS one year after the diagnosis of DVT were analyzed. One RCT revealed a significant reduction in symptoms, whereas another RCT failed to show any benefit of using compression stockings. Conclusions: At this time, it does not seem to be justifiable to entirely abandon the recommendations regarding compression stockings to prevent PTS in patients with DVT. There is evidence favoring compression stockings, but there is also evidence showing no benefit of compression stockings.

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Heparin Assays and Bleeding Complications in Treatment of Deep Venous Thrombosis with Particular Reference to Retroperitoneal Bleeding

Thrombosis and Haemostasis ◽

10.1055/s-0038-1661293 ◽

1985 ◽

Vol 53 (02) ◽

pp. 278-281 ◽

Cited By ~ 33

Author(s):

H Asbjørn Holm ◽

Ulrich Abildgaard ◽

Sigmund Kalvenes

Keyword(s):

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Major Bleeding ◽

Bleeding Complications ◽

Minor Bleeding ◽

Thrombin Time ◽

Heparin Infusion ◽

Retroperitoneal Bleeding ◽

Heparin Activity ◽

The Difference

SummaryBleeding complications occurred in 30 (11%) out of 280 patients who received continuous heparin infusion for deep venous thrombosis (DVT). 22 (8%) had minor while 8 patients (3%) had major bleeding complications (1 intrathoracic [fatal], 2 gastrointestinal and 5 retroperitoneal). Heparin activity, in daily drawn blood samples, was determined by four assays (chromogenic substrate [CS] assay, activated partial thromboplastin time [APTT], thrombin time with citrated plasma [CiTT] and thrombin time with recalcified plasma [CaTT]). The differences in median heparin activity between patients with minor bleeding and patients with no bleeding did not reach significance for any of the tests. In patients with major bleeding, the differences were significant with the CS (p = .011) and the CaTT (p = .030) assays. Patients with retroperitoneal bleeding had significantly increased median activity judged by all four assays: CS (p = .002), CaTT (p = .003), APTT (p = .010), CiTT (p = .029). The difference was most pronounced after four days of heparin treatment, but there was a considerable overlap with patients without bleeding.

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