Early Intervention Recommended for Certain Blood Clots

New clinical guidelines for physicians that for the first time suggest the use of pharmacomechanical thrombolysis (PMT) for acute iliofemoral deep vein thrombosis (DVT) in conjunction with anticoagulation drug therapy.

The new American College of Chest Physicians (ACCP, Northbrook, IL, USA) venous thromboembolic (VTE) disease guidelines improve on the previous ACCP standard, which recommended the use of anticoagulation drug therapy alone for the treatment of DVT. While anticoagulation alone mitigates the risk of clot propagation and pulmonary embolism, it often fails to clear the blockage. PMT, however, which consists of brief, high-pressure pulsed injections of a concentrated fibrinolytic agent to thrombus via a multi-sidehole catheter, has shown improved results in dissolving the DVT clot. The new guidelines appear in a supplement to the July 2008, issue of the journal Chest.

"This is a major change in the recommendations for the care of these patients with extensive DVT, and represents a major advance in treatment. Adopting an initial strategy of thrombus removal will improve the quality of life of these patients and potentially avoid recurrent DVT in the future,” said Anthony Comerota, M.D., director of the Jobst Vascular Center and adjunct professor of surgery at the University of Michigan (Ann Arbor, USA).

DVT can lead to serious consequences, including pulmonary embolism (PE) or post-thrombotic syndrome (PTS). DVT commonly affects the leg veins such as the femoral vein or the popliteal vein or the deep veins of the pelvis. Occasionally the veins of the arm are affected (known as Paget-Schrötter disease). The most common risk factors are recent surgery or hospitalization; 40% of these patients did not receive heparin prophylaxis. Other risk factors include advanced age, obesity, infection, immobilization, use of combined (estrogen-containing) forms of hormonal contraception, tobacco usage and air travel—known as economy class syndrome, a combination of immobility and relative dehydration--are some of the better-known causes.

Related Links:
American College of Chest Physicians
University of Michigan