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Indications for Catheter-Directed Thrombolysis in the Management of Acute Proximal Deep Venous Thrombosis

Patterson, BO; Hinchliffe, R; Loftus, IM; Thompson, MM; Holt, PJ (2010) Indications for Catheter-Directed Thrombolysis in the Management of Acute Proximal Deep Venous Thrombosis. ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY, 30 (4). 669 - 674 (6). ISSN 1079-5642 https://doi.org/10.1161/ATVBAHA.109.200766
SGUL Authors: Holt, Peter James Edward Thompson, Matthew Merfyn Loftus, Ian

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Abstract

Deep vein thromboses (DVTs) cause significant morbidity and mortality in the general population. Oral anticoagulation therapy may reduce thrombus propagation but does not cause clot lysis and therefore does not prevent postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) can be used to treat DVTs as an adjunct to medical therapy, but there is no consensus defining exact indications. Current evidence suggests that CDT can reduce clot burden and DVT recurrence and consequently prevents the formation of PTS compared with systemic anticoagulation. Appropriate indications include younger individuals with acute proximal thromboses, a long life expectancy, and relatively few comorbidities. Limb-threatening thromboses may also be treated with CDT, although the subsequent mortality remains high. A number of randomized controlled trials are currently under way comparing the longer-term outcomes of CDT compared with anticoagulation alone. Initial reports suggest that venous patency and valvular function are better maintained after CDT. The effectiveness of combined pharmacomechanical thrombectomy and the role of vena cava filters need to be investigated further before strong recommendations can be made. The reported short-term outcomes following catheter-based intervention for DVT are encouraging in selected patients. Further evidence is required to establish long-term benefits and cost-effectiveness.

Item Type: Article
Additional Information: PubMed ID: 20237328
Keywords: Acute Disease, Administration, Oral, Anticoagulants, Catheterization, Peripheral, Cost-Benefit Analysis, Drug Costs, Evidence-Based Medicine, Fibrinolytic Agents, Health Care Costs, Humans, Patient Selection, Postthrombotic Syndrome, Quality of Life, Recurrence, Risk Assessment, Stockings, Compression, Thrombectomy, Thrombolytic Therapy, Time Factors, Treatment Outcome, Vascular Patency, Venous Thrombosis, Venous Valves, Science & Technology, Life Sciences & Biomedicine, Hematology, Peripheral Vascular Disease, Cardiovascular System & Cardiology, anticoagulants, thrombolysis, thrombosis, catheter directed thrombolysis, MAY-THURNER-SYNDROME, ILIAC VEIN COMPRESSION, POSTTHROMBOTIC SYNDROME, ENDOVASCULAR MANAGEMENT, CONTROLLED-TRIAL, CLINICAL-TRIAL, THROMBECTOMY, THERAPY, THROMBOEMBOLISM, ANTICOAGULATION, anticoagulants, thrombolysis, thrombosis, catheter directed thrombolysis
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Cardiac (INCCCA)
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) > Vascular & Cardiac Surgery (INCCVC)
Journal or Publication Title: ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY
ISSN: 1079-5642
Related URLs:
Dates:
DateEvent
1 April 2010Published
Web of Science ID: WOS:000275712500008
URI: https://openaccess.sgul.ac.uk/id/eprint/104111
Publisher's version: https://doi.org/10.1161/ATVBAHA.109.200766

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