PDF herunterladen
Semin intervent Radiol 2012; 29(01): 023-028
DOI: 10.1055/s-0032-1302448
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Acute Deep Vein Thrombosis Cases in the Real World

Seth J. Klein
1   The Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
,
Suresh Vedantham
1   The Interventional Radiology Section, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
16. April 2012 (online)

Auch verfügbar auf
    Lizenzen und Reprints

Abstract

Practicing interventional radiologists (IRs) are routinely faced with challenging decisions that pertain to the management of patients with acute deep vein thrombosis (DVT). In this article, we describe five questions that are commonly posed by interventionalists and discuss both the indirect published evidence as well as our own experience in dealing with these issues. Our aim is to address procedural and, perhaps more importantly, nonprocedural-related knowledge domains with which the IR physician is less familiar and are often not directly addressed by published data or evidence-based clinical practice guidelines. This discussion is meant to facilitate a stronger understanding of the published literature as it pertains to the justifiable indications for endovascular thrombolytic therapy, the optimal use of anticoagulant therapy, and the reasonable use of adjuncts such as inferior vena cava filters and elastic compression stockings. Our goal is to provide a framework for practicing IRs to help them make the best clinical decisions for their individual patients and, ultimately, achieve optimal DVT treatment outcomes.

Keywords

deep vein thrombosis (dvt) - postthrombotic syndrome (pts) - iliofemoral dvt (ifdvt) - catheter-directed thrombolysis (cdt) - pharmacomechanical cdt (pcdt) - venous thromboembolism (vte)
 

  • References

  • 1 Vedantham S, Thorpe PE, Cardella JF , et al. Quality improvement guidelines for the treatment of lower extremity deep vein thrombosis with use of endovascular thrombus removal. J Vasc Interv Radiol 2006; 17 (3) 435-447 ; quiz 448
    CrossrefPubMedGoogle Scholar
  • 2 Vedantham S. Interventions for deep vein thrombosis: re-emergence of a promising therapy. Am J Med 2008; 121: S28-S39
    PubMedGoogle Scholar
  • 3 Prandoni P, Lensing AWA, Cogo A , et al. The long-term clinical course of acute deep venous thrombosis. Ann Intern Med 1996; 125 (1) 1-7
    CrossrefPubMedGoogle Scholar
  • 4 Prandoni P, Lensing AW, Prins MH , et al. Below-knee elastic compression stockings to prevent the post-thrombotic syndrome: a randomized, controlled trial. Ann Intern Med 2004; 141 (4) 249-256
    CrossrefPubMedGoogle Scholar
  • 5 Brandjes DP, Büller HR, Heijboer H , et al. Randomised trial of effect of compression stockings in patients with symptomatic proximal-vein thrombosis. Lancet 1997; 349 (9054) 759-762
    CrossrefPubMedGoogle Scholar
  • 6 Partsch H, Kaulich M, Mayer W. Immediate mobilisation in acute vein thrombosis reduces post-thrombotic syndrome. Int Angiol 2004; 23 (3) 206-212
    PubMedGoogle Scholar
  • 7 Markel A, Manzo RA, Bergelin RO, Strandness Jr DE. Valvular reflux after deep vein thrombosis: incidence and time of occurrence. J Vasc Surg 1992; 15 (2) 377-382 , discussion 383–384
    CrossrefPubMedGoogle Scholar
  • 8 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 (1) 130-137
    CrossrefPubMedGoogle Scholar
  • 9 AbuRahma AF, Perkins SE, Wulu JT, Ng HK. Iliofemoral deep vein thrombosis: conventional therapy versus lysis and percutaneous transluminal angioplasty and stenting. Ann Surg 2001; 233 (6) 752-760
    CrossrefPubMedGoogle Scholar
  • 10 Vedantham S, Grassi CJ, Ferral H , et al; Technology Assessment Committe of the Society of Interventional Radiology. Reporting standards for endovascular treatment of lower extremity deep vein thrombosis. J Vasc Interv Radiol 2006; 17 (3) 417-434
    CrossrefPubMedGoogle Scholar
  • 11 Jaff MR, McMurtry MS, Archer SL , et al. Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. Circulation 2011; 123 (16) 1788-1830
    CrossrefPubMedGoogle Scholar
  • 12 Ginsberg JS, Hirsh J, Julian J , et al. Prevention and treatment of postphlebitic syndrome: results of a 3-part study. Arch Intern Med 2001; 161 (17) 2105-2109
    CrossrefPubMedGoogle Scholar
  • 13 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 (1) 39-49
    CrossrefPubMedGoogle Scholar
  • 14 Douketis JD, Crowther MA, Foster GA, Ginsberg JS. Does the location of thrombosis determine the risk of disease recurrence in patients with proximal deep vein thrombosis?. Am J Med 2001; 110 (7) 515-519
    CrossrefPubMedGoogle Scholar
  • 15 Kahn SR, Shrier I, Julian JA , et al. Determinants and time course of the postthrombotic syndrome after acute deep venous thrombosis. Ann Intern Med 2008; 149 (10) 698-707
    CrossrefPubMedGoogle Scholar
  • 16 Delis KT, Bountouroglou D, Mansfield AO. Venous claudication in iliofemoral thrombosis: long-term effects on venous hemodynamics, clinical status, and quality of life. Ann Surg 2004; 239 (1) 118-126
    CrossrefPubMedGoogle Scholar
  • 17 Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg 2002; 24 (3) 209-214
    CrossrefPubMedGoogle Scholar
  • 18 Sharifi M, Mehdipour M, Bay C, Smith G, Sharifi J. Endovenous therapy for deep venous thrombosis: the TORPEDO trial. Catheter Cardiovasc Interv 2010; 76 (3) 316-325
    CrossrefPubMedGoogle Scholar
  • 19 Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest 2008; 133 (6, Suppl) 454S-545S
    CrossrefPubMedGoogle Scholar
  • 20 Vedantham S, Millward SF, Cardella JF , et al; Society of Interventional Radiology. Society of Interventional Radiology position statement: treatment of acute iliofemoral deep vein thrombosis with use of adjunctive catheter-directed intrathrombus thrombolysis. J Vasc Interv Radiol 2006; 17 (4) 613-616
    CrossrefPubMedGoogle Scholar
  • 21 Enden T, Klow NE, Sandvik L , et al. Catheter-directed thrombolysis vs. anticoagulation alone in deep vein thrombosis: results of an open, randomized, controlled trial reporting on short-term patency. J Thromb Haemost 2009; 7: 1268-1275
    CrossrefPubMedGoogle Scholar
  • 22 Vedantham S. Catheter-directed thrombolysis for deep vein thrombosis. Curr Opin Hematol 2010; 17 (5) 464-468
    CrossrefPubMedGoogle Scholar
  • 23 Hansson PO, Sörbo J, Eriksson H. Recurrent venous thromboembolism after deep vein thrombosis: incidence and risk factors. Arch Intern Med 2000; 160 (6) 769-774
    CrossrefPubMedGoogle Scholar
  • 24 Heit JA, Mohr DN, Silverstein MD, Petterson TM, O'Fallon WM, Melton III LJ. Predictors of recurrence after deep vein thrombosis and pulmonary embolism: a population-based cohort study. Arch Intern Med 2000; 160 (6) 761-768
    CrossrefPubMedGoogle Scholar
  • 25 Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 2003; 362 (9383) 523-526
    CrossrefPubMedGoogle Scholar
  • 26 Christiansen SC, Cannegieter SC, Koster T, Vandenbroucke JP, Rosendaal FR. Thrombophilia, clinical factors, and recurrent venous thrombotic events. JAMA 2005; 293 (19) 2352-2361
    CrossrefPubMedGoogle Scholar
  • 27 Schulman S, Rhedin AS, Lindmarker P , et al; Duration of Anticoagulation Trial Study Group. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995; 332 (25) 1661-1665
    CrossrefPubMedGoogle Scholar
  • 28 Kearon C, Ginsberg JS, Anderson DR , et al; SOFAST Investigators. Comparison of 1.  month with 3 months of anticoagulation for a first episode of venous thromboembolism associated with a transient risk factor. J Thromb Haemost 2004; 2 (5) 743-749
    CrossrefPubMedGoogle Scholar
  • 29 Schulman S, Lockner D, Juhlin-Dannfelt A. The duration of oral anticoagulation after deep vein thrombosis. A randomized study. Acta Med Scand 1985; 217 (5) 547-552
    PubMedGoogle Scholar
  • 30 Baglin T, Luddington R, Brown K, Baglin C. Incidence of recurrent venous thromboembolism in relation to clinical and thrombophilic risk factors: prospective cohort study. Lancet 2003; 362 (9383) 523-526
    CrossrefPubMedGoogle Scholar
  • 31 Schulman S, Granqvist S, Holmström M , et al. The duration of oral anticoagulant therapy after a second episode of venous thromboembolism. The Duration of Anticoagulation Trial Study Group. N Engl J Med 1997; 336 (6) 393-398
    CrossrefPubMedGoogle Scholar
  • 32 Ridker PM, Goldhaber SZ, Danielson E , et al; PREVENT Investigators. Long-term, low-intensity warfarin therapy for the prevention of recurrent venous thromboembolism. N Engl J Med 2003; 348 (15) 1425-1434
    CrossrefPubMedGoogle Scholar
  • 33 Kearon C, Gent M, Hirsh J , et al. A comparison of three months of anticoagulation with extended anticoagulation for a first episode of idiopathic venous thromboembolism. N Engl J Med 1999; 340 (12) 901-907
    CrossrefPubMedGoogle Scholar
  • 34 Palareti G, Cosmi B, Legnani C , et al. D-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med 2006; 355 (17) 1780-1789
    CrossrefPubMedGoogle Scholar
  • 35 Agnelli G, Prandoni P, Santamaria MG , et al; Warfarin Optimal Duration Italian Trial Investigators. Three months versus one year of oral anticoagulant therapy for idiopathic deep venous thrombosis. N Engl J Med 2001; 345 (3) 165-169
    CrossrefPubMedGoogle Scholar
  • 36 Lee AY, Levine MN, Baker RI , et al; Randomized Comparison of Low-Molecular-Weight Heparin versus Oral Anticoagulant Therapy for the Prevention of Recurrent Venous Thromboembolism in Patients with Cancer (CLOT) Investigators. Low-molecular-weight heparin versus a coumarin for the prevention of recurrent venous thromboembolism in patients with cancer. N Engl J Med 2003; 349 (2) 146-153
    CrossrefPubMedGoogle Scholar
  • 37 Meyer G, Marjanovic Z, Valcke J , et al. Comparison of low-molecular-weight heparin and warfarin for the secondary prevention of venous thromboembolism in patients with cancer: a randomized controlled study. Arch Intern Med 2002; 162 (15) 1729-1735
    CrossrefPubMedGoogle Scholar
  • 38 Hull RD, Pineo GF, Brant RF , et al; LITE Trial Investigators. Long-term low-molecular-weight heparin versus usual care in proximal-vein thrombosis patients with cancer. Am J Med 2006; 119 (12) 1062-1072
    CrossrefPubMedGoogle Scholar
  • 39 Schulman S, Kearon C, Kakkar AK , et al; RE-COVER Study Group. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med 2009; 361 (24) 2342-2352
    CrossrefPubMedGoogle Scholar
  • 40 Prandoni P, Lensing AW, Prins MH , et al. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med 2002; 137 (12) 955-960
    CrossrefPubMedGoogle Scholar
  • 41 Piovella F, Crippa L, Barone M , et al. Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica 2002; 87 (5) 515-522
    PubMedGoogle Scholar
  • 42 Young L, Ockelford P, Milne D, Rolfe-Vyson V, Mckelvie S, Harper P. Post-treatment residual thrombus increases the risk of recurrent deep vein thrombosis and mortality. J Thromb Haemost 2006; 4 (9) 1919-1924
    CrossrefPubMedGoogle Scholar
  • 43 Palareti G, Cosmi B, Legnani C , et al. D-dimer testing to determine the duration of anticoagulant therapy. N Engl J Med 2006; 355: 1780-1789
    CrossrefPubMedGoogle Scholar
  • 44 The STILE Investigators. Results of a prospective randomized trial evaluating surgery versus thrombolysis for ischemia of the lower extremity. The STILE trial. Ann Surg 1994; 220 (3) 251-266 ; discussion 266–268
    CrossrefPubMedGoogle Scholar
  • 45 Ouriel K, Veith FJ, Sasahara AA ; Thrombolysis or Peripheral Arterial Surgery (TOPAS) Investigators. A comparison of recombinant urokinase with vascular surgery as initial treatment for acute arterial occlusion of the legs. N Engl J Med 1998; 338 (16) 1105-1111
    CrossrefPubMedGoogle Scholar
  • 46 Decousus H, Leizorovicz A, Parent F , et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. . Prévention du Risque d'Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338 (7) 409-415
    CrossrefPubMedGoogle Scholar
  • 47 Saeed I, Garcia M, McNicholas K. Right ventricular migration of a recovery IVC filter's fractured wire with subsequent pericardial tamponade. Cardiovasc Intervent Radiol 2006; 29 (4) 685-686
    CrossrefPubMedGoogle Scholar
  • 48 Galhotra S, Amesur NB, Zajko AB, Simmons RL. Migration of the Günther Tulip inferior vena cava filter to the chest. J Vasc Interv Radiol 2007; 18 (12) 1581-1585
    CrossrefPubMedGoogle Scholar
  • 49 Bush RL, Lin PH, Bates JT, Mureebe L, Zhou W, Lumsden AB. Pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis: safety and feasibility study. J Vasc Surg 2004; 40 (5) 965-970
    CrossrefPubMedGoogle Scholar
  • 50 Lin PH, Zhou W, Dardik A , et al. Catheter-direct thrombolysis versus pharmacomechanical thrombectomy for treatment of symptomatic lower extremity deep venous thrombosis. Am J Surg 2006; 192 (6) 782-788
    CrossrefPubMedGoogle Scholar
  • 51 Tsai J, Georgiades CS, Hong K, Kim HS. Presumed pulmonary embolism following power-pulse spray thrombectomy of upper extremity venous thrombosis. Cardiovasc Intervent Radiol 2006; 29 (4) 678-680
    CrossrefPubMedGoogle Scholar
  • 52 Kahn SR, Shbaklo H, Shapiro S , et al. Effectiveness of compression stockings to prevent the post-thrombotic syndrome (the SOX Trial and Bio-SOX biomarker substudy): a randomized controlled trial. BMC Cardiovasc Disord 2007; 7: 21
    CrossrefPubMedGoogle Scholar