Catheter-directed thrombolytic therapy for thoracic deep vein thrombosis is safe and effective in selected patients with and without cancer

Maleux, Geert; Marchal, P; Palmers, Marleen; Heye, Sam; Verhamme, Peter; Vaninbroukx, Johan; Verhaeghe, Raymond

doi:10.1007/s00330-010-1771-1

Cited by 25 publications

(12 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies compared the degree of clot lysis and short-term complications between patients with vs those without cancer who had presented with extensive DVT or PE. [17][18][19] Although comparable results between cancer and noncancer patient groups were observed, these studies provide a low level of evidence because of insufficient statistical power and patient selection bias. Nonetheless, there is no strong evidence to routinely exclude patients for consideration of thrombolysis on the basis of the presence of malignancy alone.…”

Section: Initial Management Of a First Episode Of Cancer-associated Vmentioning

confidence: 86%

Treatment of cancer-associated thrombosis

Lee

Peterson

2013

Blood

165

140

View full text Add to dashboard Cite

Therapeutic options for the management of venous thromboembolism (VTE) in patients with cancer remain very limited. Although low-molecular-weight heparin monotherapy has been identified as a simple and efficacious regimen compared with an initial parenteral anticoagulant followed by long-term therapy with a vitamin K antagonist, many clinical questions remain unanswered. These include optimal duration of anticoagulant therapy, treatment of recurrent VTE, and the treatment of patients with concurrent bleeding or those with a high risk of bleeding. Treatment recommendations from consensus clinical guidelines are largely based on retrospective reports or extrapolated data from the noncancer population with VTE, as randomized controlled trials focused on cancer-associated thrombosis are sorely lacking. Furthermore, with improvements in imaging technology and extended survival duration of patients with cancer, we are encountering more unique challenges, such as the management of incidental VTE. Clinicians should be aware of the limitations of the novel oral anticoagulants and avoid the use of these agents because of the paucity of evidence in the treatment of cancer-associated thrombosis.

show abstract

Section: Initial Management Of a First Episode Of Cancer-associated Vmentioning

confidence: 86%

Treatment of cancer-associated thrombosis

Lee

Peterson

2013

Blood

165

140

View full text Add to dashboard Cite

show abstract

“…However, Kim et al (11) and Maleux et al (12) found no significant difference between cancer and noncancer patients in the safety of thrombolytic therapy for DVT in the lower and upper limbs and in the thoracic cavity.…”

Section: Discussionmentioning

confidence: 99%

“…Maleux et al (12) reported that an intracranial hemorrhage occurred in a cancer patient with an unknown and asymptomatic cerebral metastasis during catheter-directed thrombolytic therapy for thoracic deep vein thrombosis in a retrospective trial. This fatal complication underlines the need for brain imaging before starting thrombolytic therapy, especially for cancer patients.…”

Section: Discussionmentioning

confidence: 99%

Endoluminal treatment for venous vascular complications of malignant tumors

Xiao

Tong

Shen

2012

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract. The aim of this study was to explore the efficacy and safety of interventional treatment for venous vascular complications of malignant tumors. Sixty-one patients with venous vascular complications of malignant tumors were treated from May 2002 to May 2009; 37 men and 24 women with mean age 57.8 years (33-82 years). Lesions included acute deep vein thrombosis (n=18); venous stenosis or occlusion (n=32); tumor embolus in vein (n=11). The interventional therapeutic operations included vena cava filter implantation, transcatheter thrombolytic therapy, recanalization, percutaneous transluminal angioplasty (PTA) and stenting. The success rate of thrombolysis and stent implantation, the clinical success rate, complications, recurrence rate of the treated region and survival duration were recorded. Eighteen patients accepted filter and thrombolytic therapy with a success rate of 100%; total urokinase dosage was 7.42±1.49 (4.5-10) million units. Symptoms disappeared (n=15), were palliated (n=3) and thrombi were completely dissolved (n=2), almost completely dissolved (n=8, >90%), partially dissolved (n=6, 50-90%) and not dissolved (n=2, <50%). No pulmonary embolism emerged after the operation. Forty-three patients accepted recanalization, PTA and stent therapy with a success rate of 95.3% (41/43). Symptoms disappeared (n=25), were palliated (n=16) and did not change (n=2) 3 days following the operation. There were no severe complications during the procedure. During followup, 12 patients again suffered symptoms of venous occlusion and 47 patients died of tumor aggravation without symptom recurrence. As a result, interventional therapy has advantages including smaller injuries, well tolerance, high success rate, quick palliation of symptoms and superior clinical efficacy in the treatment of venous vascular complications for malignant tumors.

show abstract

“…No PE occurred, and major bleeding occurred in 3 (10%) patients. 69 In a retrospective series of 68 patients with UEDVT (33 associated with CVAD), Maleux et al 70 reported .90% clot lysis in 62 patients (91%) and major bleeding in 1 patient (fatal intracranial bleed) with metastatic cancer. Schindler et al used a regional infusion of urokinase (75-150 000 U/h for 24-96 hours) to treat 18 patients who developed CRT.…”

Section: Thrombolysismentioning

confidence: 99%

How I treat central venous access device–related upper extremity deep vein thrombosis

Rajasekhar

Streiff

2017

Blood

View full text Add to dashboard Cite

Central venous access device (CVAD)-related thrombosis (CRT) is a common complication among patients requiring central venous access as part of their medical care. Complications of CRT include pulmonary embolism, recurrent deep venous thrombosis, loss of central venous access, and postthrombotic syndrome. Patient-, device-, and treatment-related factors can influence the risk of CRT. Despite numerous randomized controlled trials, the clinical benefit of pharmacologic thromboprophylaxis for the prevention of CRT remains to be established. Therefore, minimizing patient exposure to known risk factors is the best available approach to prevent CRT. Venous duplex is recommended for the diagnosis of CRT. Anticoagulation for at least 3 months or the duration of the indwelling CVAD is recommended for treatment of CRT. Thrombolysis should be considered for patients at low risk for bleeding who have limb-threatening thrombosis or whose symptoms fail to resolve with adequate anticoagulation. CVAD removal should be consider for patients with bacteremia, persistent symptoms despite anticoagulation, and if the CVAD is no longer needed. Superior vena cava filters should be avoided. Prospective studies are needed to define the optimal management of patients with or at risk for CRT.

show abstract

Catheter-directed thrombolytic therapy for thoracic deep vein thrombosis is safe and effective in selected patients with and without cancer

Cited by 25 publications

References 21 publications

Treatment of cancer-associated thrombosis

Treatment of cancer-associated thrombosis

Endoluminal treatment for venous vascular complications of malignant tumors

How I treat central venous access device–related upper extremity deep vein thrombosis

Contact Info

Product

Resources

About