Thrombolysis for Lower-Extremity Deep Vein Thrombosis

Elimination of the embolic potential of existing thrombus, restoration of unobstructed flow, prevention of further thrombosis, and preservation of venous valve function are the ideal goals of therapy for acute deep vein thrombosis (DVT). Meeting these goals will not only prevent pulmonary embolus, but will also minimize long-term sequelae of venous hypertension and development of postthrombotic syndrome (PTS). Treatment strategies aimed at eliminating or reducing risk of PTS should focus on preserving valvular function and eliminating risk of continued venous obstruction after acute DVT. Thrombolytic agents are an attractive form of early therapy because they have the ability to eliminate obstructive thrombus in the deep veins, and should therefore help provide protection against PTS. Perceived benefits of early and rapid recanalization in preserving valve function have been the basis for lytic therapy to treat acute DVT. Data from the National Venous Registry and subsequent reports on the role of catheter-directed thrombolysis for treatment of acute lower-extremity DVT indicate that the technique is safe and effective in select patients. More recently, implementation of percutaneous mechanical devices designed to quickly remove acute thrombus has had a significant impact on time and cost of catheter-directed thrombolysis procedure. Although the long-term benefits of this form of therapy are not yet completely known, the Venous Registry can serve as a guide to the judicious selection of patients who will most benefit from this aggressive form of therapy.