Thrombolytic therapy for deep vein thrombosis |
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Authors: | Suresh Vedantham |
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Institution: | (1) Mallinckrodt Institute of Radiology, 510 South Kingshighway, Box 8131, St. Louis, MO 63110, USA |
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Abstract: | Opinion statement The incorporation of endovascular interventions into mainstream clinical practice for patients with deep vein thrombosis (DVT)
has been changing rapidly as a result of four major trends. First, there now is a much greater appreciation among practicing
physicians of the major impact of the postthrombotic syndrome (PTS) on DVT patients’ late quality of life. Second, there have
been rapid advances in the methods by which thrombus can be rapidly removed using endovascular techniques, resulting in greater
efficiency and treatment safety. Third, these changes together have spurred a major change in recommended DVT treatment paradigms:
there is now published expert consensus that adjunctive endovascular DVT thrombolysis should be strongly considered as a first-line
treatment strategy for selected patients with extensive acute proximal DVT. Finally, DVT researchers from multiple subspecialties
have finally come together in a major multidisciplinary clinical trial project to subject endovascular DVT thrombolysis to
the rigorous scientific testing that is needed for clinicians to be confident in its efficacy, safety, and cost-effectiveness
as a first-line DVT treatment strategy. Pending the results of this and other studies, medical physicians should routinely
inform DVT patients about the long-term consequences of DVT; ensure that they understand the importance of anticoagulant therapy
and elastic compression stockings in preventing PTS; provide a balanced discussion of the risks, benefits, and uncertainties
associated with endovascular DVT thrombolysis to patients with extensive proximal DVT; and develop collaborative clinical
and research relationships with physicians experienced with endovascular DVT therapy. |
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