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

OBJECTIVES The goal of this study was to assess the short- and long-term ef ficacy of different thrombolytic therapy regimens in patients with leg or p elvic deep venous thrombosis (DVT). BACKGROUND It is unclear whether locoregional or systemic thrombolysis is s uperior in treating acute leg DVT or even whether lysis is more effective t han anticoagulation therapy in preventing postthrombotic syndrome. METHODS A total of 250 patients averaging 40 years of age with acute DVT we re randomized into five groups to receive full heparinization (1,000 IU/h) and compression treatment, with four groups also administered locoregional tissue plasminogen activator (20 mg/day) or urokinase (100,000 IU/day) or s ystemic streptokinase (3,000,000 IU daily) or urokinase (5,000,000 IU daily ). AU groups then received anticoagulation and compression treatment for on e year. Primary efficacy criteria included the change after one year in the number of dosed vein segments and the occurrence of postthrombotic syndrom e. RESULTS Systemic thrombolytic therapy significantly reduced the number of c losed vein segments after 12 months in patients with acute DVT compared wit h conventional treatment (p < 0.05). Postthrombotic syndrome also occurred with less frequency in systemically treated patients versus controls (p < 0 .001). High-dose thrombolysis led to better rates of complete recanalizatio n after seven days (p < 0.01) than locoregional lysis. However, 12 patients receiving thrombolysis (9 systemic, 3 local) suffered major bleeding compl ications; 9 patients on systemic treatment developed pulmonary emboli. CONCLUSIONS Systemic thrombolytic treatment for acute DVT achieved a signif icantly better short- and long-term clinical outcome than conventional hepa rin/anticoagulation therapy but at the expense of a serious increase in maj or bleeding and pulmonary emboli. Given the inherent risks for such serious complications, systemic thrombolysis, although effective, should be used s electively in limb-threatening thrombotic situations. (J Am Coll Cardiol 20 00;36:1336-43) (C) 2000 by the American College of Cardiology.