Hazards of thrombolytic therapy in deep vein thrombosis

Meissner, Alfred Jerzy; Misiak, Andrzej; Ziemski, J.M.; Scharf, Rüdiger E.; Rudowski, W; Huszcza, Sławomir; Kucharski, W; Wisławski, S

doi:10.1002/bjs.1800741111

Cited by 40 publications

(6 citation statements)

References 16 publications

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“…Most patients were treated with anticoagulants (heparin) and thrombolytic drugs (streptokinase). Our clinical experience with employing thrombolytic therapy for the years 1965-1985 and the subsequent observations for the period 1986 -1990 showed that the therapy was not free from serious complications, such as fatal intracranial hemorrhages or life-endangering internal bleeding [20,21]. Those failures in the management of patients with acute proximal DVT of the lower extremities and the growing number of patients with contraindications to anticoagulants contributed to an extension of our list of indications for surgical treatment.…”

Section: Methodsmentioning

confidence: 99%

Surgical Strategy for Management of Deep Venous Thrombosis of the Lower Extremities

Meissner

Huszcza

1996

World j. surg.

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Clinical experience proves that there is a considerable group of patients with acute proximal deep vein thrombosis (DVT) of the legs who have absolute or relative contraindications to anticoagulants or thrombolytic agents but require immediate medical treatment. The aim here is to present our strategy for qualifying patients for venous thrombectomy and the technique of the operation in patients with acute iliofemoral DVT. A total of 268 patients with DVT were evaluated. A proximal thrombosis was diagnosed in 225 cases (84%), and acute thrombosis was found in 126 (56%) of these 225 patients. Venous thrombectomy with temporary arteriovenous fistula was performed in 30 patients. In the remaining patients initial treatment included heparin, acenocumarol, or both in 61, thrombolytic agents in 26, and other therapy in 9 cases. Three patients died during the early postoperative period. Minor nonhemorrhagic complications were observed in four operated patients. One patient developed wound hematoma. In all but three operated cases the patency of the iliac and femoral veins with leg swelling in 16 patients was observed 1 year after fistula closure. There were no episodes of rethrombosis during this period. None of the thrombectomized patient had leg ulcers. Eight patients were free of clinical symptoms related to DVT. We believe that venous thrombectomy provides a good chance for satisfactory restoration of venous outflow in patients with acute proximal DVT. Venous thrombectomy with temporary arteriovenous fistula represents the treatment of choice in patients with acute, proximal DVT and with contraindications to heparin treatment.

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Section: Methodsmentioning

confidence: 99%

Surgical Strategy for Management of Deep Venous Thrombosis of the Lower Extremities

Meissner

Huszcza

1996

World j. surg.

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“…24,29,31 Most of these reports involved bleeding at the puncture site and are reported as major if they required transfusion. These reports are magnified, however, by the report of 8% mortality in the series of patients studied by Meissner and associates 32 who were treated with systemic streptokinase. A review of 6 studies of systemic thrombolysis demonstrated that thrombolysis was achieved 3.7 times more often than anticoagulation but with the consequence of 2.9 times the incidence of major bleeding complications.…”

Section: Systemic Thrombolytic Therapymentioning

confidence: 97%

Catheter-Directed Thrombectomy and Thrombolysis for Symptomatic Lower-Extremity Deep Vein Thrombosis: Review of Current Interventional Treatment Strategies

Lin¹,

Ochoa²,

Duffy³

2010

Perspectives in Vascular Surgery and Endovascular Therapy

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Deep vein thromboses (DVT) along with its clinical sequelae represent a major health care challenge in our society. An acute massive DVT can result in pulmonary embolism resulting in sudden death. Although oral or systemic anticoagulation therapy may minimize thrombus propagation, it remains ineffective in removing thrombus burden and consequently does not prevent postthrombotic syndrome. Recent advances in catheter-based interventions have led to the development of a variety of minimally invasive endovascular strategies to remove venous thrombi. These technologies use various principles, including catheter-directed thrombolytic infusion, rheolytic thrombectomy, mechanical fragmentation, or ultrasound energy to remove intraluminal thrombi. This article reviews the current advances in this technology and discusses the techniques of percutaneous treatment strategies of venous thrombotic conditions using various devices, including the AngioJet Power Pulse system, Trellis, and ultrasound-accelerated EkoSonic system. Finally, the authors' institutional experiences using these interventional treatment strategies in patients with acute and chronic DVT are discussed.

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“…The effectiveness of systemic thrombolysis to achieve early clot lysis had been investigated in a number of trials which found it to be associated with high rates of serious bleeding complications with relatively modest rates of thrombus clearance [72][73][74]. Catheterdirected thrombolysis (CDT) involves delivery of thrombolytic agents directly through a catheter traversing the thrombus.…”

Section: Deep Vein Thrombosismentioning

confidence: 99%

Interventional treatment of venous thromboembolism: A review

Imberti

Ageno

Manfredini

et al. 2012

Thrombosis Research

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Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is the third most common cardiovascular disease after coronary artery disease and cerebrovascular disease and is responsible for significant morbidity and mortality in the general population. Full dose anticoagulation is the standard therapy for VTE, both for the acute and the long-term phase. The latest guidelines of the American College of Chest Physicians recommend treatment with a full-dose of unfractioned heparin (UFH), low-molecular-weight-heparin (LMWH), fondaparinux, vitamin K antagonist (VKA) or thrombolysis for most patients with objectively confirmed VTE. Catheter-guided thrombolysis and trombosuction are interventional approaches that should be used only in selected populations; interruption of the inferior vena cava (IVC) with a filter can be performed to prevent life-threatening PE in patients with VTE and contraindications to anticoagulant treatment, bleeding complications during antithrombotic treatment, or VTE recurrences despite optimal anticoagulation. In this review we summarize the currently available literature regarding interventional approaches for VTE treatment (vena cava filters, catheter-guided thrombolysis, thrombosuction) and we discuss current evidences on their efficacy and safety. Moreover, the appropriate indications for their use in daily clinical practice are reviewed.

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Hazards of thrombolytic therapy in deep vein thrombosis

Cited by 40 publications

References 16 publications

Surgical Strategy for Management of Deep Venous Thrombosis of the Lower Extremities

Surgical Strategy for Management of Deep Venous Thrombosis of the Lower Extremities

Catheter-Directed Thrombectomy and Thrombolysis for Symptomatic Lower-Extremity Deep Vein Thrombosis: Review of Current Interventional Treatment Strategies

Interventional treatment of venous thromboembolism: A review

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