Catheter Directed Thrombolysis
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Jun Du ◽  
Menglin Nie ◽  
Zhitong Yan ◽  
Jian Fu ◽  
Jianming Sun ◽  

AbstractRivaroxaban use for inferior vena cava (IVC) thrombosis after successful catheter-directed thrombolysis (CDT) is rarely reported. This study aimed at investigating the safety and efficacy of rivaroxaban for IVC thrombosis after CDT. The clinical data on 38 consecutive patients with IVC thrombosis (68% male; mean age, 51.5 ± 16.5), who received rivaroxaban after CDT between July 2017 and January 2020, were retrospectively analyzed in this study. Safety and efficacy of rivaroxaban (bleedings and recurrent venous thromboembolism), cumulative prevalence of post-thrombotic syndrome (PTS), primary patency, clinically driven target lesion revascularization rate, and other adverse events including all-cause mortality and vascular events (systemic embolism, acute coronary syndrome, ischemic stroke, and transient ischemic attack) were retrospectively analyzed. Of the 38 patients who received rivaroxaban for IVC thrombosis after CDT, 27 (71%) had an anticoagulant duration of 6 months and 11 patients (29%) of more than 6 months. Four patients (10%) suffered recurrent thrombosis. No patient suffered major bleeding, while clinically relevant nonmajor bleeding occurred in two (5%) patients. The cumulative prevalence of PTS was 18% (7/38) during the 12 months follow-up period. Primary patency at 1, 3, 6, and 12 months was 97, 92, 90, and 90%, respectively. According to follow-up data, the clinically driven target lesion revascularization of this study was 10%. Cardiovascular events and mortality did not occur in any patient during the study period. Rivaroxaban for IVC thrombosis after successful CDT can be safe and effective.

2021 ◽  
pp. 1358863X2110429
Samuel Z Goldhaber ◽  
Elizabeth A Magnuson ◽  
Khaja M Chinnakondepalli ◽  
David J Cohen ◽  
Suresh Vedantham

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.

CHEST Journal ◽  
2021 ◽  
Vol 160 (4) ◽  
pp. A2058
Harshil Shah ◽  
Shrujal Varma ◽  
Vivek Joseph Varughese ◽  
Pooja Patel ◽  
Sulee Alcacoas ◽  

Wan Nuraisyah Azzahrah Wan Zuki

Phlegmasia cerulea dolens (PCD) is a rare syndrome caused by venous thrombosis and characterised by a triad of limb oedema, cyanosis and pain. It requires early recognition as delay of treatment can cause gangrene, limb amputation and in extreme cases, death. A 67- year-old Chinese lady, with underlying hypertension, diabetes mellitus and dyslipidaemia presented to the emergency department with a 2 days history of pain, oedema and bluish discoloration over the entire left leg. She had a history of fall 6 months prior and since then she used a walking stick for mobilization. This patient underwent ultrasound doppler left lower limb , which showed features suggestive of long-segment left lower limb deep vein thrombosis. A diagnosis of PCD was made. Subsequently, she went for a CT angiogram and venography of the left lower limb which confirmed thrombosis of the left calf vein extending to the long segment of the left common iliac vein. She was commenced on intravenous heparin infusion and then underwent inferior vena cava filter insertion and catheter directed thrombolysis. Repeat venogram showed successful catheter directed thrombolysis of the left lower limb deep venous thrombosis (DVT). Treatment should be initiated as soon as the diagnosis of PCD is suspected. Currently, guidelines for treatment are lacking however 3 therapeutic options are advocated alone or in combination: anticoagulants, thrombolytic therapy, and venous thrombectomy. An early recognition of PCD and appropriate decision regarding the treatment is essential to preserve the limb.International Journal of Human and Health Sciences Supplementary Issue-2: 2021 Page: S16

2021 ◽  
pp. 10-13
I. A. Taraban ◽  
D. V. Oklei ◽  
V. О. Prasol ◽  
S. O. Beresnyev ◽  
N. I. Dmuhovskyi

Summary. Introduction. Acute thrombosis of deep veins (DVT) of the lower extremities is a pathology that requires immediate treatment, but most thrombolytics do not work effectively, except for catheter-directed thrombolysis. Research aim. Rationalization of DVT treatment, determination of the catheter thrombolysis method as the most effective way to eliminate proximal thrombosis of deep veins. The analysis was based on the results of the treatment by different thrombolytic drugs the patients with the given pathology. Results and discussion. According to the analysis the most effective method of DVT treatment is catheter-guided administration of streptokinase, because streptokinase is the most effective anticoagulant, and its local action on the mass of the thrombus allows for complete elimination of the thrombus in a relatively short time without the counter allergic reaction to the infusion of streptokinase. Conclusions. Catheter-directed infusion of streptokinase as a method of treatment of acute thrombosis of the lower extremities has significantly better treatment results compared to other methods of treatment of this pathology.

2021 ◽  
Vol 108 (Supplement_6) ◽  
B Likupe ◽  
L Shelmerdine ◽  
G Stansby

Abstract Introduction NICE guidelines relating to catheter directed thrombolysis for iliofemoral DVT were renewed in March 2020. These state that patients should be considered if they have: symptoms lasting <14 days, good functional status, a life expectancy of 1 year or more and a low bleeding risk. Anecdotally, we felt the quality of DVT referrals to our tertiary Vascular Centre, were not meeting these guidelines. Method Vascular registrar on call handovers between October 2019 and October 2020 were reviewed, identifying 85 referrals for patients with iliofemoral DVT. Referrals were evaluated for the inclusion of information pertaining to the four aforementioned criteria. A search of electronic patient records identified those patients who subsequently received thrombolysis. Results Of the 85 patients, 10.6%(n = 9) received thrombolysis. Over 90% (n = 77) of referrals included none or only one of the four criteria. The most frequently included criterion was “days since symptom onset” (n = 41), but this was still fewer than half of referrals (48%). Interestingly, eight patients were noted to have concurrent malignancy with none receiving thrombolysis, although malignancy itself is not a contraindication. Neither functional status nor information relating to life expectancy was included in any of their referrals. Conclusions Good quality referrals are essential in aiding clinical decision-making surrounding treatment options for iliofemoral DVT. Our audit revealed the majority of referrals lacked the information NICE guidelines have outlined, revealing a great need for improvement. Future work in this area will look at implementing changes to bring referrals more closely in line with current guidelines.

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