Upper-extremity deep-vein thrombosis: thrombolytic therapy with anistrepalase

Deep Vein Thrombosis: Intraarterial Application of a Thrombolytic Agent

A case of an older patient with developing venous gangrene of the left upper extremity and contraindications to systemic thrombolytic therapy are presented. Intraarterial application of a lytic agent was successfully applied. It is concluded that, in selected high-risk patients with developing venous gangrene and failed anticoagulation therapy, the intraarterial application of a thrombolytic agent may be the therapy of choice.

An Integrative Review of Outcomes in Patients with Acute Primary Upper Extremity Deep Venous Thrombosis Following No Treatment or Treatment with Anticoagulation, Thrombolysis, or Surgical Algorithms

Primary upper extremity deep venous thrombosis (UEDVT) is a rare condition that typically affects young patients and can cause considerable long-term morbidity. Proposed treatments have included rest, heat, elevation of the affected limb, anticoagulation, thrombolysis, surgical decompression, percutaneous transluminal angioplasty (PTA), and stenting. However, the optimal management of primary UEDVT remains controversial. This study was an integrative review of the English-language literature since 1965 on primary UEDVT, with comparison of long-term symptoms, rethrombosis, and pulmonary embolism in 4 treatment algorithms: rest, heat, and elevation alone; anticoagulation alone; surgical decompression without thrombolysis; and algorithms including thrombolysis. Forty-one studies describing 559 patients met the criteria for inclusion. Statistically significant differences were found among the 4 treatment algorithms in the incidence of residual symptoms (p< 0.000), the incidence of pulmonary embolism (p<0.000), and the incidence of rethrombosis (p<0.027). Residual symptoms and the severity of residual symptoms were greatest in the rest, heat, and elevation algorithm (74%), followed by the surgical (60%), anticoagulation (44%), and thrombolysis (22%) algorithms. Pulmonary embolism was also greatest in the rest, heat, and elevation algorithm (12%), followed by the anticoagulation (7%), thrombolysis (1%), and surgical algorithms (0%), while rethrombosis was greatest in the thrombolytic algorithm (7%) followed by the surgical (3%), anticoagulation (2%), and rest, heat, and elevation (0%) algorithms. These results support the current clinical practice of a staged, multidisciplinary approach to treatment of primary UEDVT that includes thrombolytic therapy and possible surgical decompression. Further studies are needed to evaluate the natural history of patients treated with thrombolysis alone, to assess the optimal timing of surgical decompression, and to determine the best use of PTA and stenting in the multidisciplinary approach.

Non-lower extremity deep vein thrombosis

This article reviews the prevalence, etiology, pathophysiology, clinical manifestations, diagnoses, and treatment of non-lower extremity deep vein thrombosis (DVT). The discussion includes upper extremity DVT, mesenteric venous occlusion, jugular vein thrombosis, and central venous thrombosis.

Treatment options for deep venous thrombosis

Once the diagnosis of deep venous thrombosis (DVT) has been established the focus shifts to management of the disease. The goals of acute treatment of DVT are several: arrest growth of the thrombus, dissolve or remove the thrombus, and prevent embolizations of the thrombus. Although these goals have remained constant, the initial management of DVT has undergone a series of evolutions during the past decade, affecting both acute treatment and disposition decisions. As this article discusses, emergency medicine is at the cutting edge of these changes.