THE POTENTIAL ROLE OF THROMBOLYTIC THERAPY IN VENOUS THROMBOSIS

被引:54
作者
MARKEL, A [1 ]
MANZO, RA [1 ]
STRANDNESS, DE [1 ]
机构
[1] UNIV WASHINGTON, SCH MED,DEPT SURG,DIV VASC SURG,RF-25, 1959 NE PACIFIC ST, SEATTLE, WA 98195 USA
关键词
D O I
10.1001/archinte.152.6.1265
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background.-Anticoagulant therapy for lower extremity deep-vein thrombosis (DVT) has been shown to reduce mortality from pulmonary embolism, but subsequent morbidity from the postthrombotic syndrome remains high. Thrombolytic therapy produces higher lysis rates of venous thrombi than heparin alone. Some studies suggest a lower incidence of postthrombotic sequelae after early use of streptokinase. These potential benefits are limited to those patients without contraindications for this therapy. Methods.-For the past 3 years we have prospectively studied patients with DVT documented by duplex scanning. The records of these patients were reviewed to determine what proportion of this population would have been candidates for thrombolytic therapy. For this analysis, contraindications to the use of thrombolytic agents included: (1) recent surgery (<1 month); (2) recent major trauma; (3) active or recent bleeding; (4) brain disease (cerebrovascular accident, brain tumor, arteriovenous malformation); (5) pregnancy; and (6) bleeding diathesis. Also, patients with prior ipsilateral DVT and those with acute symptoms present for 7 or more days were not considered to be candidates for thrombolytic therapy. Results.-A contraindication to thrombolytic therapy was present in 194 (93%) of 209 patients with a diagnosis of DVT, including four patients with a relative contraindication. Two or more contraindications were present in 65 cases (31%). Recent surgery was the most frequent factor precluding therapy, being present in 71 patients. A history of DVT in the affected leg was present in 45 patients. Conclusions.-Only 15 (7%) of 209 patients with DVT exhibited no contraindications for thrombolytic treatment. Only a small fraction of patients with venous thrombosis will be potential candidates for this therapy.
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页码:1265 / 1267
页数:3
相关论文
共 15 条
  • [1] ALBRECHTSSON U, 1981, ARCH SURG-CHICAGO, V116, P33
  • [2] THE USE OF DICUMAROL AS AN ANTICOAGULANT - EXPERIENCE IN 2,307 CASES
    ALLEN, EV
    HINES, EA
    KVALE, WF
    BARKER, NW
    [J]. ANNALS OF INTERNAL MEDICINE, 1947, 27 (03) : 371 - 381
  • [3] ARENSEN H, 1982, ACTA MED SCAND, V211, P65
  • [4] DEEP-VEIN THROMBOSIS TREATED WITH STREPTOKINASE OR HEPARIN - FOLLOW-UP OF A RANDOMIZED STUDY
    COMMON, HH
    SEAMAN, AJ
    ROSCH, J
    PORTER, JM
    DOTTER, CT
    [J]. ANGIOLOGY, 1976, 27 (11) : 645 - 654
  • [5] TREATMENT OF DEEP-VEIN THROMBOSIS WITH STREPTOKINASE
    DUCKERT, F
    MULLER, G
    NYMAN, D
    BENZ, A
    PRISENDER, S
    MADAR, G
    DASILVA, MA
    WIDMER, LK
    SCHMITT, HE
    [J]. BRITISH MEDICAL JOURNAL, 1975, 1 (5956) : 479 - 481
  • [6] COMPARATIVE RANDOMIZED TRIAL OF HEPARIN VERSUS STREPTOKINASE IN THE TREATMENT OF ACUTE PROXIMAL VENOUS THROMBOSIS - INTERIM-REPORT OF A PROSPECTIVE TRIAL
    ELLIOT, MS
    IMMELMAN, EJ
    JEFFERY, P
    BENATAR, SR
    FUNSTON, MR
    SMITH, JA
    SHEPSTONE, BJ
    FERGUSON, AD
    JACOBS, P
    WALKER, W
    LOUW, JH
    [J]. BRITISH JOURNAL OF SURGERY, 1979, 66 (12) : 838 - 843
  • [7] FIESSINGER JN, 1987, ANN VASC SURG, V1, P522
  • [8] RANDOMIZED CONTROLLED TRIAL OF TISSUE PLASMINOGEN-ACTIVATOR IN PROXIMAL DEEP VENOUS THROMBOSIS
    GOLDHABER, SZ
    MEYEROVITZ, MF
    GREEN, D
    VOGELZANG, RL
    CITRIN, P
    HEIT, J
    SOBEL, M
    WHEELER, HB
    PLANTE, D
    KIM, H
    HOPKINS, A
    TUFTE, M
    STUMP, D
    BRAUNWALD, E
    [J]. AMERICAN JOURNAL OF MEDICINE, 1990, 88 (03) : 235 - 240
  • [9] POOLED ANALYSES OF RANDOMIZED TRIALS OF STREPTOKINASE AND HEPARIN IN PHLEBOGRAPHICALLY DOCUMENTED ACUTE DEEP VENOUS THROMBOSIS
    GOLDHABER, SZ
    BURING, JE
    LIPNICK, RJ
    HENNEKENS, CH
    [J]. AMERICAN JOURNAL OF MEDICINE, 1984, 76 (03) : 393 - 397
  • [10] KAKKAR VV, 1985, AM J SURG, V150, P54