Abstract
Lower extremity deep vein thrombosis (DVT) is a common disease associated with serious short term and long term complications. Its conventional treatment has been anticoagulation. Thrombolytic treatment has been used for DVT for over 40 years. More recently catheter directed thrombolysis has taken over systemic thrombolysis. This technique is useful to prevent post thrombotic syndrome (PTS) after DVT.
In this review article we present a case of DVT thrombolysis in our hospital, look at the pathophysiology of PTS, the mechanism of thrombolysis and the current status of thrombolysis in DVT.
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References
- Wells P.S, Forster A.J;Thrombolysis in deep vein thrombosis: Is there still an indication?. Thrombosis and Haemostasis 2001; 86: 499–508.
- Salzman EW, Hirsh J; The epidemiology, pathogenesis and natural history of venous thrombosis. In: Colman RW, Hirsh J, Marder VJ, Salzman EW editors. Hemostasis and thrombosis: basic principles and clinical practice. Philadelphia: J.B. Lippincott company, 1994: 1275–96.
- Bergqvist D, Jandteg S, Johansen L, et al; Cost of long-term complications of deep venous thrombosis of the lower extremeties: an analysis of defined patient population in Sweden. Ann Intern Med 1997; 126: 454–7.
- Alesh I, Kayali F, Stein PD; Catheter-Directed Thrombolysis(intrathrom bus injection) in treatment of deep vein thrombosis: A systemic review. Catheterization and cardiovascular interventions 2007; 70: 143–148.
- Akesson H, Brudin L, Dahlstrom JA, et al; Venous function assessed during a 5 year period after acute iliofemoral venous thrombosis treated with anticoagulation. Eur J Vasc Surg 1990; 4: 43–48.
- Labropoulos N, Waggoner T, Sammis W, et al; The effect of venous thrombus location and extent on the development of post-thrombotic signs and symptoms.J Vasc surg 2008; 48: 407–412.
- Elsharawy M.., Elzayat E;Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surgery 2002; 24: 209–214.
- Thomas ML, McAllister V; The radiological progression of deep venous thrombosis. Radiology 1971; 99: 37.
- Mavor GE, Galloway JMD; Iliofemoral venous thrombosis: Pathlogical coonsiderations and surgical management. Br J Surg 1969; 56: 43–59.
- Pirad D, Bellens B, Vereecken P; The post-thrombotic syndrome-a condition to prevent. Dermatology Online J 2008; 14: 1087–1108.
- Hopkins NF, Wolfe JH; ABC of vascular disease: deep venous insufficiency and occlusion. BMJ 1992; 304: 107–10.
- Van Haarst EP, Liasis N, Van Ramshorst B, et al; The development of valvular incompetence after deep vein thrombosis: a 7 year follow-up study with dupplex scanning. Eur J Vasc Endovasc Surg 1996; 12: 295–9.
- Browse NL, Thomas ML, Pim HP; Streptokinase and deep vein thrombosis. BMJ. 1968; 3: 717–720.
- Robertson BR, Nilsson IM, Nylander G; Value of streptokinase and heparin in treatment of acute deep venous thrombosis. A coded investigation. Acta Chir Scand. 1968; 134: 203–208.
- Semba CP, Dake MD; Iliofemoral deep venous thrombosis: aggressive therapy with catheter-directed thrombolysis. Radiology 1994; 191: 487–494.
- Kahn SR, Ginsberg JF; The post –thrombotic syndrome: current knowledge, controversies, and directions for future research. Blood Rev 2002; 16: 155–65.
- Meissner MH; Thrombolytic therapy for acute deep vein thrombosis and the venous registery. Rev Cardiovasc Med 2002; 3: 53–60.
- Nicolaides AN, Hussein MK, Szendro G, et al; The relationship of venous ulceration with ambulatory venous pressure measurements. J Vasc Surg 1993; 17: 414–419.
- Johnson BF, Manzo RA, Bergelin RO, et al; Relationship between changes in the deep venous system and the development of the postthrombotic syndrome after an acute episode of lower limb deep vein thrombosis: a one to six year follow-up. J Vasc Surg 1995; 21: 307–313.
- Johnson BF, Manzo RA, Bergelin RO, et al; The site of residual abnormalities in the leg veins in long-term follow-up after deep venous thrombosis and their relationship to the development of the postthrombotic syndrome. Int Angiol 1996; 15: 14–19.
- Meissner MH, Manzo RA,Bergelin RO, et al; Deep venous insufficiency: the relationship between lysis and subsequent reflux. J Vasc Surg 1993; 18: 596–608.
- Prandoni P, Lesing A, Cogo A, et al; The long term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125: 1–7.
- Bollinger A, Isenring G, Franzeck UK; Lymphatic microangiopathy: a complication of severe chronic venous incompetence(CVI). Lymphology 1982; 15: 60–5.
- Kahn SR, Hirsch A, Shrier I; Effect of post-thrombotic syndrome on health-related quality of life after deep venous thrombosis. Arch Intern Med 2002; 162: 1144–8.
- Brandjes DP, Buller HR, Heijboer H, et al; Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349: 759–62.
- Comerota AJ, Gravett MH; Current status of thrombolysis for acute deep vein thrombosis. Phlebolymphology 2008; 15: 85–93.
- Alkjaersig N, Fletcher AP, Sherry S; The mechanism of clot dissolution by plasmin. J Clin Invest 1959; 38: 1086–1095.
- Schulman S, Granqvist S, Juhlin-Dannfelt A, et al; Long-term sequelae of calf vein thrombosis treated with heparin or low dose streptokinase. Acta Med Scand 1986; 219: 349–57.
- Heinrich F, Heinrich U. North Baden venous lysis trial(NBVL): multicentre prospective randomized phlebographically controlled trial on the effect of ultra-high versus conventional doses of streptokinase in fresh leg-pelvis venous thrombose. Vasc Med 1998; 3: 87–94.
- Schulman S, Lockner D, Granqvist S, et al; A comparative randomized trial of low dose versus high dose streptokinase in deep vein thrombosis of the thigh. Thromb Haemost 1984; 51: 261–5.
- Goldhaber SZ, Hirsch DR, MacDougall RC, et al; Bolus recombinant urokinase versus heparin in deep vein thrombosis: A randomized controlled trial. Am Heart J. 1996; 132: 314–8.
- Kiil J, Carvalho A, Sakso P, et al; Urokinase or heparin in the management of patients with deep vein thrombosis?. Acta Chir Scand 1981; 147: 529–32.
- Goldhaber SZ, Meyerovitz MF, Green D, et al; Randomized controlled trial of tissue plasminogen activator (rt-PA) in proximal deep venous thrombosis. Am J Med 1990; 88: 235–40.
- Turpie AAG, Levine M, Hirsh J, et al; Tissue plasminogen activator (rtPA) vs heparin in deep vein thrombosis: results of a randomized trial. Chest 1990; 97: 172S–5S
- Verhaeghe R, Besse P, Bounameaux H, et al; Multicentre pilot study of the efficacy and safety of systemic rt-PA adminstration in the treatment of deep vein thrombosis of the lower extremities and/or pelvis. Thromb Res 1989; 55: 5–11.
- Bounameaux H, Banga JD, Bluhmki E, et al; Double blind, randomized comparison of systemic continuous infusion of 0.25 mg vs 0.50 mg/kg/24 h of alteplase over 3 to 7 days for treatment of deep venous thrombosis in heparinized patients: results of the European thrombolysis with rt-PA in venous thrombosis (ETTT) trial. Thromb Haemost 1992; 67: 306–9.
- Schwieder G, Grimm W, Siemens H, et al; Intermittent regional therapy with rt-PA is not superior to systemic thrombolysis in deep vein thrombosis(DVT). A German multicentre trial. Thromb Haemost 1995; 74: 1240–3.
- Patel NH, Stookey KR, Ketcham DB, et al; Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by MayThurner Syndrome. J Vasc Interv Radiol 2000; 11: 1297–1302.
- Ly B, Njaastad AM, Sandbaek G, et al; [Catheter-directed lysis of iliofemoral venous thrombosis]. Tidsskr Nor Laegeforen 2004; 124: 478–480.
- Verhaeghe R, Stockx L, Lacroix H, et al; Catheter-directed lysis of iliofemoral vein thrombosis with use of rt-PA. Eur Radiol 1997; 7: 996–1001.
- Singh H, Masuda EM; Comparing short-term outcomes of femoralpopliteal and iliofemoral deep venous thrombosis: Early lysis and development of reflux. Ann Vasc Surg 2005; 19: 74–79.
- Kim HS, Preece SR, James H, et al; Safety of catheter-directed thrombolysis for deep venous thrombosis in cancer patients. J Vasc Surg 2008; 47: 388–394.
- 43-. Comerota AJ, Throm RC, Mathias SD, et al; Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health related quality of life. J Vasc Surg 2000; 32: 130–137.
