TY - JOUR
T1 - Catheter-directed thrombolysis for deep vein thrombosis
T2 - 2021 update
AU - Goldhaber, Samuel Z.
AU - Magnuson, Elizabeth A.
AU - Chinnakondepalli, Khaja M.
AU - Cohen, David J.
AU - Vedantham, Suresh
N1 - Funding Information:
The authors declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Samuel Z Goldhaber – research grant support from Bristol Myers Squibb, Boston Scientific Corporation, Janssen; personal fees from Bayer, Agile. Elizabeth A Magnuson – research grant support from Abbott Vascular, Cardiovascular Systems, Inc., Corvia Medical, Edwards Lifesciences, Svelte Medical Systems. Khaja M Chinnakondepalli – nothing to disclose. David J Cohen – research grant support and consulting fees from Abbott Vascular, Boston Scientific Corporation, Medtronic, Phillips. Suresh Vedantham – research grant support (in kind support only) from Medi USA.
Funding Information:
Dr. Vedantham’s work is supported by grants from the National Heart Lung and Blood Institute (U01-HL088476, UH3-HL138325) and National Center for Advancing Translational Sciences (UL1-TR002345).
Publisher Copyright:
© The Author(s) 2021.
PY - 2021/12
Y1 - 2021/12
N2 - Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.
AB - Catheter-directed thrombolysis (CDT) has been utilized as an adjunct to anticoagulant therapy in selected patients with deep vein thrombosis (DVT) for approximately 30 years. CDT used to be limited to patients with DVT causing acute limb threat and those exhibiting failure of initial anticoagulation, but has expanded over time. Randomized trials evaluating the first-line use of CDT for proximal DVT have demonstrated that CDT does not produce a major reduction in the occurrence of post-thrombotic syndrome (PTS) and that it is poorly suited for elderly patients and those with limited thrombus extent or major risk factors for bleeding. However, CDT does offer selected patients with acute iliofemoral DVT improvement in reducing early DVT symptoms, in achieving reduction in PTS severity, and in producing an improvement in health-related quality of life (QOL). Clinical practice guidelines from medical and surgical societies are now largely aligned with the randomized trial results. This review offers the reader an update on the results of recently completed clinical trials, and additional guidance on appropriate selection of patients with DVT for catheter-directed thrombolytic therapy.
KW - deep vein thrombosis (DVT)
KW - post-thrombotic syndrome
KW - quality of life
KW - thrombolysis
KW - venous thromboembolism (VTE)
UR - http://www.scopus.com/inward/record.url?scp=85116444971&partnerID=8YFLogxK
U2 - 10.1177/1358863X211042930
DO - 10.1177/1358863X211042930
M3 - Article
C2 - 34606385
AN - SCOPUS:85116444971
SN - 1358-863X
VL - 26
SP - 662
EP - 669
JO - Vascular Medicine (United Kingdom)
JF - Vascular Medicine (United Kingdom)
IS - 6
ER -