Pulse-Spray Treatment of Subclavian and Jugular Venous Thrombi with Recombinant Tissue Plasminogen Activator

A Case of Idiopathic Upper Extremitiy Deep Vein Thrombosis

“…Anti coagulation is the cornerstone of treatment [1], [17] and thrombolysis is preferred only in catheter induced thrombosis or in lower extremity DVT [17.23,25,27-29,32, 35]. rtPA, percutaneous thrombectomy, surgery were considered by a few collegues [26,27,33,34]. In our patient we went for anticoagulation therapy due to ease of administration, financial constraints.…”

“…25 Thrombolysis works best if used within several weeks of the onset of symptoms, because progressive thrombus organization will limit its effectiveness at later dates. [17,25,26]Many case series of thrombolysis in carefully selected patients have reported excellent outcomes with only minor bleeding complications, such as occasional hematomas or oozing at venipuncture or catheter sites. [25,[27][28][29] The thrombolysis studies are small, however, so the risks of intracranial or gastrointestinal hemorrhage may not be fully appreciated, although they probably approximate those for catheter-directed thrombolysis of lower extremity DVT The best thrombolysis candidates are young, otherwise healthy patients with primary UEDVT, patients with symptomatic SVC syndrome, and those who require preservation of a mandatory central venous catheter.…”

Heparin‐induced thrombocytopenia (HIT) due to heparin flushes: a report of three cases

“…Venography showed total obstruction of a short segment of the right subclavian vein proximal to the junction of the internal jugular vein, and the patient began a therapeutic dose of intravenous porcine heparin (25000 U day 21 ). Twenty-five milligrams of recombinant tissue plasminogen activator (Genentech, San Francisco, CA) was injected into the thrombus on the second and third hospital days [13]. By the hospital day 4 the patient's platelet count had fallen to 121 000 mL 21 .…”

Paget-Schroetter Syndrome in the Young and Active

“…Most of the studies used thrombolytics in patients with a history of signs and symptoms a duration of up to 3 weeks if other variables coexist, such as age, cause of the condition, coexistent hematologic disorders, or malignancy. 12,19,22 This was considered in our patient before the therapy in addition to other variables that would affect the success of the intervention. The best candidates tend to be the young and healthy, with primary UEDVT or Paget-Schroetter syndrome.…”

“…The best candidates tend to be the young and healthy, with primary UEDVT or Paget-Schroetter syndrome. 12,19,22 To prevent clot or fibrin formation around the catheter during treatment with thrombolytics, heparin is usually given concurrently.…”