Thrombolysis in deep vein thrombosis: Is there still an indication?

The most accepted therapy for DVT consists of anticoagulation with unfracti onated heparin or low molecular weight heparin, followed by variable durati on oral anticoagulation but thrombolytic therapy has been proposed in addit ion to standard anticoagulation. This paper reviews the literature on post thrombotic syndrome, the natural history of vein patency after therapy, and we perform a systematic review, using accepted standards for meta-analysis , to determine the outcomes when thrombolytic therapy is used to treat DVT. We demonstrate that thrombolytic therapy for DVT results in a significant increase in the risk of major hemorrhage and a significant increase in the rate of vein patency. However, although thrombolytic therapy is advantageou s over anticoagulation as measured by early vein patency, a benefit in term s of a reduction in PTS risk, is unproven. Our review also shows that there is no evidence that there is a difference in efficacy between thrombolytic agents or that local therapy differs from systemic therapy. Finally, the p otential role of catheter directed therapy is unknown since appropriate tri als have not been performed but it is reasonable to use catheter directed t herapy in patients with phlegmasia cerulea dolens. We conclude that more wo rk is needed to define the role of thrombolytic therapy but it is too early to abandon this therapeutic modality.