Prevention of post-thrombotic syndrome: Role of fibrinolysis in proximal deep vein thrombosis

BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a relatively common clinical condition, with an incidence estimated at 1-2 cases per 1000 inhabitants per year. Post-thrombotic syndrome (PTS) is a chronic complication which particularly affects patients with proximal DVT (ilio-femoral); it significantly impacts upon patients' quality of life and it also has major health-economic implications. METHODS: We report our experience with ultrasound accelerated thrombolysis EKOS system in treatment of patients affected by proximal DVT. RESULTS: In our experience, we treated three cases of proximal DVT adopting ultrasound accelerated thrombolysis with EKOS system. Technical success rate was 100% in absence of embolic or hemorrhagic complications. The mean follow-up was 18 months: there were no thrombotic recurrences and none of the three patients had clinical signs of PTS. Loco-regional thrombolysis applied in selected cases of proximal DVT, unlike traditional therapy with oral anticoagulants, is able to ensure a rapid resolution of the thrombotic process, thus limiting valvular damage, that underlies the development of PTS. In recent years new techniques like mechanical, pharmaco-mechanical and ultrasound enhanced thrombolysis were developed. They allow a further reduction in both duration of treatment and drugs dose used, compared to pharmacological thrombolysis alone and also lead to an overall costs' reduction. CONCLUSIONS: In conclusion, from both a review of the literature and our own experience, pharmacological thrombolysis has proven to be a safe and effective technique in the treatment of proximal DVT, in order to prevent the development of PTS; nevertheless, it appears appropriate that those techniques are reserved to highly selected patients and practiced in centers with adequate experience and resources.

Data di pubblicazione: 2017
Titolo: Prevention of post-thrombotic syndrome: Role of fibrinolysis in proximal deep vein thrombosis
Autori: Rocca, Tiberio; Manfrini, Andrea; Traina, Luca; Acciarri, Pierfilippo; Asbarro, Vincenzo G.
Rivista: ACTA PHLEBOLOGICA
Parole Chiave: Lower extremity deep vein thrombosis; Postthrombotic syndrome; Thrombolytic therapy; Cardiology and Cardiovascular Medicine
Abstract in inglese: BACKGROUND: Deep vein thrombosis (DVT) of the lower limbs is a relatively common clinical condition, with an incidence estimated at 1-2 cases per 1000 inhabitants per year. Post-thrombotic syndrome (PTS) is a chronic complication which particularly affects patients with proximal DVT (ilio-femoral); it significantly impacts upon patients' quality of life and it also has major health-economic implications. METHODS: We report our experience with ultrasound accelerated thrombolysis EKOS system in treatment of patients affected by proximal DVT. RESULTS: In our experience, we treated three cases of proximal DVT adopting ultrasound accelerated thrombolysis with EKOS system. Technical success rate was 100% in absence of embolic or hemorrhagic complications. The mean follow-up was 18 months: there were no thrombotic recurrences and none of the three patients had clinical signs of PTS. Loco-regional thrombolysis applied in selected cases of proximal DVT, unlike traditional therapy with oral anticoagulants, is able to ensure a rapid resolution of the thrombotic process, thus limiting valvular damage, that underlies the development of PTS. In recent years new techniques like mechanical, pharmaco-mechanical and ultrasound enhanced thrombolysis were developed. They allow a further reduction in both duration of treatment and drugs dose used, compared to pharmacological thrombolysis alone and also lead to an overall costs' reduction. CONCLUSIONS: In conclusion, from both a review of the literature and our own experience, pharmacological thrombolysis has proven to be a safe and effective technique in the treatment of proximal DVT, in order to prevent the development of PTS; nevertheless, it appears appropriate that those techniques are reserved to highly selected patients and practiced in centers with adequate experience and resources.
Digital Object Identifier (DOI): 10.23736/S1593-232X.17.00374-5
Handle: http://hdl.handle.net/11392/2376752
Appare nelle tipologie:03.1 Articolo su rivista

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