THROMBOLYTIC THERAPY FOR DEEP VENOUS THROMBOSIS - A CLINICAL REVIEW

Although anticoagulation is the treatment most commonly chosen for pat ients suffering from deep venous thrombosis (DVT), thrombolytic therap y offers the promise of dissolving the thrombus within the deep venous system, restoring patency and preserving valve function. If this is a chieved, the incidence and severity of post-thrombotic syndrome can be reduced. Data from 13 studies comparing anticoagulant therapy with th rombolytic therapy for DVT in 591 patients have shown that, among thos e treated with heparin, 4% had significant or complete lysis, 14% had partial lysis and 82% failed to improve or worsened. Of those receivin g lytic therapy, 45% had significant or complete lysis, 18% had partia l lysis and 37% failed to improve or worsened. Long-term follow-up of randomized patients has shown that those with successful lysis had a l ower incidence of post-thrombotic syndrome and improved long-term veno us function. The failure rate of systemic lytic therapy among patients suffering iliofemoral venous thrombosis is high; therefore, catheter- directed thrombolysis has been adopted with increasing success. Thromb olytic therapy, delivered systemically using catheter-directed techniq ues, should be considered as an important alternative in the treatment of patients with DVT.