Thrombolytic Therapy

Prepared by William Marston, MD

Corresponding chapter in Handbook of Venous Disorders: Chapters 20, 21 and 22

• Enden T, Klyw NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G et al. Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency. J Thromb Haemostasis 2009;7:1268-75.

PMID: 19422443

Comment: Early results of randomized study of lysis compared to anticoagulation for DVT in 103 patients finding a significant increase in the incidence of iliofemoral patency with lysis. Long-term follow-up and functional outcomes are planned in this patient population.

• Comerota AJ, The ATTRACT Trial: Rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovas Ther 2009;21(4):221-4. Epub 2010 Jan 3

PMID: 20047905

Comment: The ATTRACT Trial will randomize a sizable group of patients at multiple centers to thrombolysis compared to
anticoagulation after iliofemoral or femoropopliteal DVT. The primary outcome measure is to determine the incidence of postthrombotic syndrome in each group over a 24 month follow-up.

• Comerota AJ, Throm RC, Mathias SD, Haughton S, Mewissen M. Catheter-directed thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J Vasc Surg 2000;32:130-7.

PMID: 10876214

Comment: Successful thrombolysis for DVT was associated with significantly better QOL than failed thrombolysis or anticoagulant therapy for acute iliofemoral DVT.

• Mewissen MW, Seabrook GR, Meissner MH, Cynamon J, Labropoulos N, Haughton SH. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999;211:39-49.

PMID: 10189452

Comment: Results of thrombolysis for acute DVT in over 300 patients are reported from a national registry. Patency results and
incidence of complications are reviewed in detail.

• Rao AS, Konig G, Leers SA, Cho J, Rhee RY, Makaroun MS, Chaer RA. Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis:  An alternative in patients with contraindications to thrombolysis. J Vasc Surg 2009;50:1092-8.

PMID: 19782528

Comment: Many protocols for removal of acute DVT incorporate mechanical methods to reduce or eliminate the need for lytic agents and the risks of complications including major bleeding episodes. This manuscript describes the results of mechanical lysis alone in patients with contraindications to thrombolysis.