Thrombolytic therapy for deep venous thrombosis: a clinical review.

Although anticoagulation is the treatment most commonly chosen for patients suffering from deep venous thrombosis (DVT), thrombolytic therapy offers the promise of dissolving the thrombus within the deep venous system, restoring patency and preserving valve function. If this is achieved, the incidence and severity of post-thrombotic syndrome can be reduced. Data from 13 studies comparing anticoagulant therapy with thrombolytic therapy for DVT in 591 patients have shown that, among those treated with heparin, 4% had significant or complete lysis, 14% had partial lysis and 82% failed to improve or worsened. Of those receiving lytic therapy, 45% had significant or complete lysis, 18% had partial lysis and 37% failed to improve or worsened. Long-term follow-up of randomized patients has shown that those with successful lysis had a lower incidence of post-thrombotic syndrome and improved long-term venous function. The failure rate of systemic lytic therapy among patients suffering iliofemoral venous thrombosis is high; therefore, catheter-directed thrombolysis has been adopted with increasing success. Thrombolytic therapy, delivered systemically using catheter-directed techniques, should be considered as an important alternative in the treatment of patients with DVT.