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document
Short- and long-term results after thrombolytic treatment of deep venous thrombosis . OBJECTIVES The goal of this study was to assess the short- and long-term efficacy of different thrombolytic therapy regimens in patients with leg or pelvic deep venous thrombosis ( DVT ) . BACKGROUND It is unclear whether locoregional or systemic thrombolysis is superior in treating acute leg DVT or even whether lysis is more effective than anticoagulation therapy in preventing postthrombotic syndrome . METHODS A total of 250 patients averaging 40 years of age with acute DVT were randomized into five groups to receive full heparinization ( 1,000 IU/h ) and compression treatment , with four groups also administered locoregional tissue plasminogen activator ( 20 mg/day ) or urokinase ( 100,000 IU/day ) or systemic streptokinase ( 3,000,000 IU daily ) or urokinase ( 5,000,000 IU daily ) . All groups then received anticoagulation and compression treatment for one year . Primary efficacy criteria included the change after one year in the number of closed vein segments and the occurrence of postthrombotic syndrome . RESULTS Systemic thrombolytic therapy significantly reduced the number of closed vein segments after 12 months in patients with acute DVT compared with conventional treatment ( p < 0.05 ) . Postthrombotic syndrome also occurred with less frequency in systemically treated patients versus controls ( p < 0.001 ) . High-dose thrombolysis led to better rates of complete recanalization after seven days ( p < 0.01 ) than locoregional lysis . However , 12 patients receiving thrombolysis ( 9 systemic , 3 local ) suffered major bleeding complications ; 9 patients on systemic treatment developed pulmonary emboli . CONCLUSIONS Systemic thrombolytic treatment for acute DVT achieved a significantly better short- and long-term clinical outcome than conventional heparin/anticoagulation therapy but at the expense of a serious increase in major bleeding and pulmonary emboli . Given the inherent risks for such serious complications , systemic thrombolysis , although effective , should be used selectively in limb-threatening thrombotic situations .
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Intervention_Control
thrombolytic treatment
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Intervention_Physical
thrombolytic therapy
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Intervention_Control
full heparinization ( 1,000 IU/h ) and compression treatment , with four groups
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Intervention_Control
locoregional tissue plasminogen activator ( 20 mg/day )
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Intervention_Control
urokinase ( 100,000 IU/day )
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Intervention_Control
systemic streptokinase ( 3,000,000 IU daily )
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Intervention_Control
urokinase ( 5,000,000 IU daily )
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Intervention_Control
anticoagulation and compression treatment for one year
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Intervention_Physical
Systemic thrombolytic therapy
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Intervention_Control
Systemic thrombolytic treatment
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Outcome_Physical
closed vein segments
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Outcome_Physical
closed vein segments
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Outcome_Physical
Postthrombotic syndrome
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Outcome_Physical
complete recanalization
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Outcome_Physical
major bleeding complications
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Outcome_Adverse-effects
pulmonary emboli