Interventional treatment of deep vein thrombosis offers additional benefits over anticoagulation therapy alone
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 component.
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 this indication.
For more information:
- Hofmann L. Why intervention for DVT? Should this catch on?