Using an interventional
approach to treat certain patients suffering from deep vein thrombosis may
offer long-term benefits difficult to achieve with anticoagulation therapy
alone, according to recently presented data.
Interventional treatment for iliac and femoral deep vein
thrombosis, according to Lawrence Hofmann, MD, chief of interventional
radiology at the Stanford University School of Medicine, can and should be
considered in some symptomatic patients. Drawing on clinical experience, study
data and several case studies, Hofmann made his case for intervention in a
presentation at the meeting.
I often find that treating these patients with
deep vein thrombosis is incredibly gratifying Hofmann said.
Patients with acute deep vein thrombosis are often very young in
their 20s and 30s and the benefit that we can impart to them can last
for 50 or 60 years.
Hofmann suggested that an interventional approach to the
treatment of symptomatic patients with deep vein thrombosis had benefits that
therapy with anticoagulants alone would not provide. Given the reflux component
and the obstructive component of deep vein thrombosis, Hofmann said, the
majority of patients suffer worse outcomes related to the obstructive component
and would likely benefit more from interventional treatment of the obstructive
He also noted that anticoagulation therapy for the
treatment of deep vein thrombosis essentially relies on the ability of
endothelial cells to produce tissue plasminogen activator to facilitate the
dissolution of the clot.
The problem is that with a clot in the common
iliac vein and a clot in the common femoral vein, there is no way your body is
going to produce enough tissue plasminogen activator to effectively dissolve
that large volume clot, Hofmann said.
He also cited results from a study suggesting that
approximately 80% of patients with deep vein thrombosis have underlying venous
stenoses. Stenting, Hofmann contended, is an effective treatment for such
stenoses. He also presented several cases from his practice in which patients
with deep vein thrombosis who were treated interventionally went on to have
favorable outcomes long after their procedures.
Anticoagulation is therapy, not
treatment, Hofmann concluded. We intervene to prevent
post-thrombotic syndrome. The National Institutes of Health mulitcenter trial,
ATTRACT, that will be ongoing will hopefully give us level 1 data to support
For more information:
- Hofmann L. Why
intervention for DVT? Should this catch on?