Document Detail


Catheter-directed thrombolysis for treatment of deep venous thrombosis in the upper extremities.
MedLine Citation:
PMID:  19641959     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Traditional anticoagulant treatment of deep venous thrombosis (DVT) in the upper extremities (UEDVT) is associated with a relatively high incidence of postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) for UEDVT would provide efficient thrombolysis with less subsequent PTS than during traditional anticoagulation. Primary efficacy, complications, and long-term results after CDT are reported in a retrospective cohort (2002-2007) of patients (n = 30) with DVT in the upper extremities. PTS was assessed by a modified Villalta scale. UEDVT was unprovoked in 11 (37%) cases and effort related in 9 (30%) cases. The median duration of symptoms prior to CDT was 7.0 days (range, 1-30); median duration of thrombolysis treatment, 70 h (range, 24-264 h); and the median amount of rt-PA infused during CDT, 52 mg (range, 19-225 mg). Major bleeding was registered in three (9%) patients, and CDT was stopped prematurely in three patients due to local hematoma. No intracerebral bleeding, clinical pulmonary embolism, or deaths occurred during treatment. Grade II (>50%) or III (>90%) lysis was present in 29 patients (97%) at the end of CDT. Bleeding complications increased by each day of delay from the debut of symptoms to the start of treatment (OR, 1.20; 95% CI, 1.01-1.42). At follow-up (n = 29; median, 21 months; range, 5-58 months), 11 (38%) patients had occluded veins, whereas 18 (62%) had patent veins. However, stenosis of varying severity was present in eight of those with a patent vein. No patients had severe PTS, whereas six (21%) experienced mild PTS. In conclusion, our retrospective cohort study of patients with UEDVT showed that treatment restored venous drainage, with a subsequent low frequency of mild PTS at follow-up. Early intervention with CDT prevented bleeding complications.
Authors:
Anders Vik; P??l Andre Holme; Kulbir Singh; Eric Dorenberg; K??re Christian Nordhus; Satish Kumar; John-Bjarne Hansen
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Publication Detail:
Type:  Journal Article     Date:  2009-07-30
Journal Detail:
Title:  Cardiovascular and interventional radiology     Volume:  32     ISSN:  1432-086X     ISO Abbreviation:  Cardiovasc Intervent Radiol     Publication Date:  2009 Sep 
Date Detail:
Created Date:  2009-09-04     Completed Date:  2009-12-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8003538     Medline TA:  Cardiovasc Intervent Radiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  980-7     Citation Subset:  IM    
Affiliation:
Department of Medicine, University Hospital of North Norway, Troms??, Norway. anders.vik@unn.no
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Angioplasty, Balloon
Anticoagulants / administration & dosage*
Catheterization, Peripheral / methods*
Female
Humans
Logistic Models
Male
Middle Aged
Phlebography
Postthrombotic Syndrome / prevention & control
Punctures
Radiography, Interventional
Retrospective Studies
Statistics, Nonparametric
Thrombolytic Therapy / methods*
Treatment Outcome
Ultrasonography, Interventional
Upper Extremity / blood supply*
Venous Thrombosis / drug therapy*,  radiography,  ultrasonography
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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