Friday, November 25, 2005

Controversy in treatment of deep vein thrombosis

The treatment of deep vein thrombosis (DVT) has been controversial concerning prevention of the post thrombotic syndrome (PTS). Although systemic thrombolytic therapy is superior to conventional anticoagulation in restoring venous flow and preserving the function of the venous valves, it is associated with greater risk of hemorrhage and its effect on meaningful clinical outcomes has been disputed.

The hemorrhage risk of systemic thrombolysis has spurred interest in local interventional modalities including catheter directed local thrombolysis and catheter extraction techniques. This review from the American Journal of Medicine explores such techniques for the prevention of PTS and discusses the complication of venous gangrene (phlegmasia cerula dolens) which may be amenable to such strategies. It draws upon experience from the National Venous Thrombosis Registry suggesting improved health related quality of life outcomes for patients treated with interventional strategies as opposed to conventional anticoagulation alone.

The take home message is that physicians should be aware that such modalities are available and should familiarize themselves with the capabilities at their individual hospitals. Physicians should be prepared to resort to these strategies in the desperate situation of venous gangrene complicating massive DVT and consider offering the techniques to selected patients with DVT for the prevention of PTS.

The paper unfortunately did not mention that the widely accepted modality for prevention of PTS, compression stockings fitted to 30-40 mm Hg, work pretty well for this purpose.

1 comment:

iuppi said...

Hello DR. RW,
I'm not posting a comment, it's more like a question. And as you've said that you will not give advices, i'll try to be very subtil...
I'm a 24 year old portuguese female. 164 cm (don't know to convert in inches) to 55 Kg (don't know either to convert in us measures), well, I'm not fat, nor even close!
I had a dvt in the femuro- piploteia (don't know in english either, sorry again) vein.
This episode occured in 28 of october (one day thrombosis, a fast one after de medicins). I was hospitalized for 12 days.
When I get out the phisiciens said that I should try lo live normally.
But, I had awfull pain during a week and sweeling.
By the moment (1 month after the episode) I walk almost normally. I have no pain. But the swell remains ( more in the upper part of the leg).
My problem is that I have no mean to know what are the post- dvt symptoms. This degree of insecurity makes me panic. I wish to know if there is a scheduale with the recover symptomes of a dvt.
So, resuming my post: Do you, Dr. RW, know if there is a internet site where I could find informations for a better recuperation behaviour (pst avoiding)- like, should I walk if that makes swell but it exercise muscles or should I rest to avoid sweel?- and normal symptons (during a time scale)?
Greetings, sorry for the language problems...