For a long time, treatment of deep venous thrombosis centered on anticoagulation alone. Depending on various factors — including provoked or unprovoked, location and whether new or recurrent episode, chances of causing a fatal pulmonary embolism or previous episodes of pulmonary embolism — the treating physician could decide the duration of the treatment from three months to lifelong.
Recently, newer modalities (catheter-directed TPA-tissue plasminogen activator thrombolysis and mechanical thrombectomy) are available to treat acute DVT. (An acute DVT ideally is less than two to three weeks old.) This helps to reduce chances of post phlebitis or thrombotic syndrome (PTS) and to reduce chances of venous hypertension long term. This may help to reduce the chances of developing a wound in the leg. Based on available research, it is less clear whether a recurrent DVT episode is avoided by using these procedures.
In a catheter-directed TPA thrombolysis, a fine plastic tube is placed at the site of the blood clot, and strong clot-busting medication (TPA) is dripped through the catheter for 12 hours continuously. The patient is brought back the next day, and a balloon angioplasty is performed to get rid of the remaining clot. Some of it may be suctioned out or macerated. The obvious disadvantage is the chance of major bleeding occurring in the brain or elsewhere as a side effect of the prolonged administration.
In a mechanical thrombectomy (INARI), a wide-bore catheter is introduced in the vein of the leg and the clot is pulled out from an umbrella filter deployed on the other side. The advantage is the avoidance of clot-busting medication and the need for multiple visits to achieve the result.
In the next issue, we will talk about the newer types of anticoagulation (blood-thinner) pills available on the market.
BIO: Dr. Aparajita is a fellowship-trained vascular and endovascular surgeon. She is a co-author of 20-plus journal articles and publications and was recently nominated for an Inspiration Award by the American Medical Association.
This column is sponsored by KSC Cardiology, and the opinions expressed herein may not reflect those of CFHN or its advertisers.
