Short- and long-term results after thrombolytic treatment of deep venous thrombosis

Schweizer, Johannes; Kirch, Wilhelm; Koch, Rainer; Elix, H; Hellner, Grit; Forkmann, Lutz; Graf, Andreas

doi:10.1016/s0735-1097(00)00863-9

Cited by 163 publications

(100 citation statements)

References 13 publications

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“…Selection criteria for identifying patients who might benefit from thrombolytic treatment are based on a subjective assessment of patient history. [5][6][7] Catheter-directed thrombolysis has reduced the rate of complications, but the time interval between the onset of symptoms and effective thrombolysis is still unclear. Several studies have shown that thrombolysis might be ineffective if administered 10 to 21 days after the onset of symptoms.…”

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confidence: 99%

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

Phinikaridou

Andía

Saha

et al. 2013

Circ: Cardiovascular Imaging

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Deep vein thrombosis (DVT) remains a significant cause of morbidity and mortality despite the improvements in diagnosis and treatment. Approximately 30% of patients with DVT develop pulmonary embolism, of whom 10% die, and 50% of patients with DVT develop long-term sequelae like the postthrombotic syndrome. 1,2 Clinical Perspective on p 440Treatment of DVT is usually achieved with anticoagulation (heparin, warfarin) or thrombolysis (plasminogen activators). Anticoagulants prevent thrombus expansion but have little effect on thrombus resolution, which occurs slowly through a natural process of organization that eventually leads to recanalization of the vein. 1,3,4 Thrombolytic agents rapidly remove the thrombus, aiding faster vein recanalization, with less thrombus recurrence and fewer postthrombotic complications.5 Systemic thrombolysis is, however, associated with serious complications, including bleeding and pulmonary emboli. Selection criteria for identifying patients who might benefit from thrombolytic treatment are based on a subjective assessment of patient history. [5][6][7] Catheter-directed thrombolysis has reduced the rate of complications, but the time interval between the onset of symptoms and effective thrombolysis is still unclear. Several studies have shown that thrombolysis might be ineffective if administered 10 to 21 days after the onset of symptoms. [8][9][10] Fibrin-rich thrombus seems to be more amenable to thrombolysis, and incorporation of collagen into a fibrin clot dramatically decreases the effectiveness of fibrinolysis in experimental models. 11,12 Identification of the extracellular protein milieu and structural microenvironment of the thrombus might therefore provide important prognostic information on its lysability.Background-Deep vein thrombosis remains a major health problem necessitating accurate diagnosis. Thrombolysis is associated with significant morbidity and is effective only for the treatment of unorganized thrombus. We tested the feasibility of in vivo magnetization transfer (MT) and diffusion-weighted magnetic resonance imaging to detect thrombus organization in a murine model of deep vein thrombosis. Methods and Results-Deep vein thrombosis was induced in the inferior vena cava of male BALB/C mice. Magnetic resonance imaging was performed at days 1, 7, 14, 21, and 28 after thrombus induction using MT, diffusion-weighted, inversion-recovery, and T1-mapping protocols. Delayed enhancement and T1 mapping were repeated 2 hours after injection of a fibrin contrast agent. Finally, excised thrombi were used for histology. We found that MT and diffusion-weighted imaging can detect histological changes associated with thrombus aging. MT rate (MTR) maps and percentage of MT rate (%MTR) allowed visualization and quantification of the thrombus protein content, respectively. The %MTR increased with thrombus organization and was significantly higher at days 14, 21, and 28 after thrombus induction (days 1, Ultrasound examination, used in the diagnosis of DVT, provides only information...

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confidence: 99%

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

Phinikaridou

Andía

Saha

et al. 2013

Circ: Cardiovascular Imaging

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“…The stimulus can range from the exposure of subendothelial proteins, as in the case of tissue injury, to the development of turbulent blood flow through a narrowed blood vessel as in atherosclerosis. In the treatment of stroke or deep vein thrombus formation, the systemic administration of thrombolytic drugs, such as tissue plasminogen activator or streptokinase, has been the most successful and widely used (1). Thrombolytic drugs work by catalyzing the activation of plasmin (an enzyme that degrades fibrin clots) from its inactive circulating precursor plasminogen from plasma.…”

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confidence: 99%

“…Thrombin induces its plateletactivating effects mainly through a family of G protein-coupled protease-activated receptors (PARs) 1 ; these receptors are activated by a mechanism in which a protease creates a new amino terminus that functions as its own tethered ligand and thus results in intramolecular activation (4,5). Of the four known PARs, three (PAR-1, PAR-3 and PAR-4) are activated by thrombin.…”

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confidence: 99%

Plasmin-mediated Activation of Platelets Occurs by Cleavage of Protease-activated Receptor 4

Quinton

Kim

Derian

et al. 2004

Journal of Biological Chemistry

109

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The activation of plasmin from its circulating precursor plasminogen is the mechanism of several clot-busting drugs used to clinically treat patients who have suffered a stroke; however, plasmin thus generated has been shown to activate platelets directly. There has been speculation as to whether plasmin interacts with the protease-activated receptors (PARs) because of its similarity in amino acid specificity with the classic platelet activator thrombin. We have investigated whether plasmin activates platelets via PAR activation through multiple complementary approaches. At concentrations sufficient to induce human platelet aggregation, plasmin released very little calcium compared with that induced by thrombin, the PAR-1 agonist peptide SFLLRN, or the PAR-4 agonist peptide AYPGKF. Stimulation of platelets with plasmin initially failed to desensitize additional stimulation with SFLLRN or AYPGKF, but a prolonged incubation with plasmin desensitized platelets to further stimulation by thrombin. The desensitization of PAR-1 had no effect on plasmininduced platelet aggregation and yielded an aggregation profile that was similar to plasmin in response to a low dose of thrombin. However, PAR-4 desensitization completely eliminated aggregation in response to plasmin. Inclusion of the PAR-1-specific antagonist BMS-200261 inhibited platelet aggregation induced by a low dose of thrombin but not by plasmin. Additionally, mouse platelets naturally devoid of PAR-1 showed a full aggregation response to plasmin in comparison to thrombin. Furthermore, human and mouse platelets treated with a PAR-4 antagonist, as well as platelets isolated from PAR-4 homozygous null mice, failed to aggregate in response to plasmin. Finally, a proteaseresistant recombinant PAR-4 was refractory to activation by plasmin. We conclude that plasmin induces platelet aggregation primarily through slow cleavage of PAR-4.

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“…Thrombolytic therapy is an effective way to relieve early-stage thrombosis, and regional or systemic thrombolysis via a superficial vein has been proven effective. However, because large doses of drugs are required for systemic thrombolysis, complications such as fatal visceral, cerebral, and/or retroperitoneal hemorrhage occur with some frequency, resulting in a high-risk benefit ratio for this therapy (Schweizer et al, 2000); therefore, the use of this modality is concerning.…”

Section: Discussionmentioning

confidence: 99%

Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis

Zheng

Zhang

et al. 2014

Genet. Mol. Res.

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ABSTRACT. We performed a meta-analysis for systematic evaluation of the status quo of catheter thrombolysis for the treatment of acute lower limb deep vein thrombosis in China. We searched the China Biomedical bibliographic database (CBM), China National Knowledge Infrastructure (CNKI), Weipu full-text electronic journals, Wanfang full-text database, and Medline (1990 through June 2011) for clinical randomized controlled trials of catheter-directed thrombolysis and superficial venous thrombolysis to compare their efficacies for the treatment of acute deep vein thrombosis. The results were analyzed by using the Cochrane-recommended RevMan 4.2 software package, and the odds ratio (OR) was used as the combined measure of efficacy. The search retrieved 8 randomized controlled trials, and meta-analysis using the total rate of effective treatment as the clinical observation index found that the combined OR for the catheter thrombolysis group versus the superficial venous thrombolysis group was significant (P < 0.01; OR = 11.78; 95% confidence interval = 6.99-19.87). In conclusion, the meta-analysis indicated that catheter thrombolysis was more effective than superficial venous thrombolysis for the treatment of acute deep vein thrombosis in the lower limb in Chinese individuals. However, the included trials were only of medium quality, so more rational and scientific clinical trials are needed to validate this conclusion.

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Short- and long-term results after thrombolytic treatment of deep venous thrombosis

Cited by 163 publications

References 13 publications

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

In Vivo Magnetization Transfer and Diffusion-Weighted Magnetic Resonance Imaging Detects Thrombus Composition in a Mouse Model of Deep Vein Thrombosis

Plasmin-mediated Activation of Platelets Occurs by Cleavage of Protease-activated Receptor 4

Catheter-directed thrombolysis in the treatment of acute deep venous thrombosis: a meta-analysis

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