thrombolysis for deep venous thrombosis

Last edited 05/2020

Thrombolytic therapy uses plasminogen activating substances such as streptokinase, urokinase and alteplase to attempt to dissolve clots in the venous system.

  • thrombolysis is not routinely recommended for patients with lower limb DVT (1,5)
  • thrombolytic agent is often delivered locally to the clot via a catheter since this may reduce the risk of haemorrhage due to systemic fibrinogenolysis.
  • useful during the acute phase of venous thrombosis to prevent valvular damage, post-thrombotic syndrome (PTS), and recurrent venous thrombosis (2)
    • the CaVenT trial reported that patients treated with CDT had significantly less PTS at 2 years compared with those treated with anticoagulation (41 vs 56 %) (3)
  • catheter-directed thrombolysis (CDT) and/or thrombectomy is currently reserved for patients with
    • iliofemoral DVT and/or limb-threatening circulatory compromise
    • acute or subacute symptoms
    • a low risk of bleeding (4).

NICE recommendations:

  • consider catheter-directed thrombolytic therapy for patients with symptomatic iliofemoral DVT who have:
    • symptoms of less than 14 days' duration and
    • good functional status and
    • a life expectancy of 1 year or more and
    • a low risk of bleeding (5)

Reference:

Related pages:

deep vein thrombosis

VTE