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Anticoagulation
New Non-surgical Treatment for Deep Vein Thrombosis
Deep vein thrombosis (DVT) results when blood clots accumulate in a vein, usually in the lower leg or thigh. This condition is extremely painful and can lead to a life-threatening situation in which clots can break loose and become lodged in the lung causing a pulmonary embolism.
The standard of care for DVT is oral anticoagulation therapy, which does not dissolve the clot but does prevent new clots from forming and greatly reduces the risk of pulmonary embolism. However, about half of DVT patients that receive anticoagulation treatment go on to develop post-thrombotic syndrome (PST), which is characterized by pain, swelling, and injury to the veins. In some cases the clot can be removed by surgery, but the current surgical procedure takes several days and is associated with a high risk for sudden bleeding.
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A new procedure, presented by Mark Garcia, MD from the Christiana Care Health System in Wilmington, De at the national meeting for the Society of Interventional Radiology, may provide an alternative treatment option for DVT. The team developed a technique they call “rapid lysis”, in which a catheter is used to deliver a clot-dissolving drug directly to the clot. Then, the clot remnants are removed from the vein with the surgical equivalent of a vacuum as the catheter is removed.
The results of the study are promising: in over 100 patients with extensive DVT, over half had full removal of the clot and complete restoration of blood flow. About 70% of patients reported no symptoms, such as swelling or pain, one year after rapid lysis (Garcia 2007 Soc of Int Rad Mtg abstract).
While many people with DVT are adequately managed with anticoagulation therapy, the risks of debilitating PST or the development of embolism are significant. For those patients with the largest and most difficult clots, where these risks are the highest, rapid lysis may become the preferred form treatment. For others, with lower risks, anticoagulation therapy may continue to be the standard of care. And, especially for patients with low bleeding risks, rapid lysis may not replace standard clot-dissolving surgery.
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