Pulse-spray Pharmacomechanical Thrombolysis for Proximal Deep Vein Thrombosis

• DOI: 10.1016/j.ejvs.2005.08.010
• Publication Date: 2005-10-06T11:11:29Z
• Authors: N. Yamada; K. Ishikura; S. Ota; A. Tsuji; M. Nakamura; M. Ito; N. Isaka; T. Nakano
• Keywords: Adult; Male; Vena Cava Filters; Vena Cava, Inferior; Iliac Vein; Intravascular devices; Fibrinolytic therapy; 03 medical and health sciences; Clinical trials; 0302 clinical medicine; Deep vein thrombosis; Humans; Thrombolytic Therapy; Aged; Medicine(all); Aged, 80 and over; Venous Thrombosis; Pulmonary embolism; Femoral Vein; Middle Aged; Urokinase-Type Plasminogen Activator; 3. Good health; Radiography; Female; Pulmonary Embolism

The aim of this study was to evaluate the efficacy, safety, and feasibility of pulse-spray pharmacomechanical thrombolysis to treat proximal deep vein thrombosis (DVT) in conjunction with the placement of a non-permanent IVC filter.We studied 31 consecutive patients with acute proximal DVT defined as the inferior vena cava (IVC), iliac vein and/or femoral vein, who were diagnosed using duplex ultrasonography and/or contrast venography. All were treated with pulse-spray urokinase. Early success was assessed by comparing the pre- and post-treatment venographic severity score. Non-permanent IVC filters were used to reduce the risk of pulmonary thromboembolism.The average total urokinase dose was 1.71 million IU (range: 0.72-3.6 million IU) and the average duration of therapy was 2.4 days. The average percentage of thrombus lysed was 85% (range: 22-100%). A large thrombus trapped by the filter was detected using cavography before extraction of the filter in one patient. There was no major treatment-related adverse event.The combination of pulse-spray pharmacomechanical thrombolysis and the prophylactic use of a non-permanent IVC filter was a safe and effective approach for treating acute proximal DVT.