Role of fibrinolysis and interventional therapy for acute venous thromboembolism

Summary

The initial goals of treatment for venous thromboembolism (VTE) are usually achieved with anticoagulation. This reviewfocuses on fibrinolysis and interventional therapy in VTE, treatments whose indications are much more controversial. The benefit-to-risk ratio of fibrinolysis in deep vein thrombosis (DVT) is dubious. Thrombolytic treatment is recommended forunstable patients with pulmonary embolism (PE), although these patients represent less than 5% of all patients hospitalized for PE. The use of thrombolytic treatment in patients with sub-massive PE remains controversial. Two indications are widely recognized for inferior vena cava filters: the first isa permanent or temporary contraindication to anticoagulation, in patients with proximal DVT or PE. The second is the occurrence of PE or propagation of the thrombus in patients treated for DVT or recurrence in patients with PE. The PREPIC study demonstrated that in acute VTE, vena cava filters reduced the risk of PE but increased that of DVT and had no effect on survival. The fact that prevention of PE is mainly observed during the short initial period following the diagnosis of an acute VTE event justifies a new randomized study with the use of retrievable filters as an adjuvant to anticoagulation in high risk patients with PE.

Keywords

Deep vein thrombosis - pulmonary embolism - ibrinolysis - thrombolysis - inferior vena cava filter

• References

• 1 Buller HR, Agnelli G, Hull RD. et al. Antithrombotic therapy for venous thromboembolic disease: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126 (Suppl. 03) 401S-28S.
• 2 Buller HR, Davidson BL, Decousus H. et al. Fondaparinux or enoxaparin for the initial treatment of symptomatic deep venous thrombosis: a randomized trial. Ann Intern Med 2004; 140: 867-73.
• 3 Goldhaber SZ, Buring JE, Lipnick RJ. et al. Pooled analyses of randomized trials of streptokinase and heparin in phlebographically documented acute deep venous thrombosis. Am J Med 1984; 76: 393-7.
• 4 Goldhaber SZ, Meyerovitz MF, Green D. et al. A randomized controlled trial of tissue plasminogen activator in proximal deep venous thrombosis. Am J Med 1990; 88: 235-40.
• 5 Watson LI, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database System Rev. 2004 03. Art. No.: CD002783. doi: 10.1002/14651858. CD002783.pub2.
• 6 Konstantinides S, Marder VJ. Thrombolysis in venous thromboembolic disease. In: Hemostasis and Thrombosis. Basic principles and clinical practice. Lippincott: Williams and Wilkins; 2006: 1317-29.
• 7 Augustinos P, Ouriel K. Invasive approaches to treatment of venous thromboembolism. Circulation 2004; 110 (Suppl I) I-27-I-34.
• 8 Mewissen MW, Seabrook GR, Meissner MH. et al. Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology 1999; 211: 39-49.
• 9 Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg 2002; 24: 209-14.
• 10 Castaneda F, Li R, Young K. et al. Catheter-directed thrombolysis in deep venous thrombosis with use of reteplase: immediate results and complications from a pilot study. J Vasc Interv Radiol 2002; 13: 577-80.
• 11 Vedantham S, Vesely TM, Parti N. et al. Lower extremity venous thrombolysis with adjunctive mechanical thrombectomy. J Vasc Interv Radiol 2002; 13: 1001-8.
• 12 Laiho MK, Oinonen A, Sugano N. et al. Preservation of venous valve function after catheter-directed and systemic thrombolysis for deep venous thrombosis. Eur J Vasc Endovasc Surg 2004; 28: 391-6.
• 13 Patel NH, Stookey KR, Ketcham DB. et al. Endovascular management of acute extensive iliofemoral deep venous thrombosis caused by May-Thurner syndrome. J Vasc Interv Radiol 2000; 11: 1297-302.
• 14 Patel NH, Plorde JJ, Meissner M. Catheter-directed thrombolysis in the treatment of phlegmasia cerulea dolens. Ann Vasc Surg 1998; 12: 471-5.
• 15 Goldhaber SZ, Visani L, De Rosa M. Acute pulmonary embolism: clinical outcomes in the International Cooperative Pulmonary Embolism Registry (ICOPER). Lancet 1999; 353: 1386-9.
• 16 Wan S, Quinlan DJ, Agnelli G. et al. Thrombolysis compared with heparin for the initial treatment of pulmonary embolism: a meta-analysis of the randomized controlled trials. Circulation 2004; 110: 744-9.
• 17 Buller HR, Davidson BL, Decousus H. et al. Subcutaneous fondaparinux versus intravenous unfractionated heparin in the initial treatment of pulmonary embolism. N Engl J Med 2003; 349: 1695-702.
• 18 Simonneau G, Sors H, Charbonnier B. et al. A comparison of low-molecular-weight heparin with unfractionated heparin for acute pulmonary embolism. The THESEE Study Group. Tinzaparine ou Heparine Standard: Evaluations dans l’Embolie Pulmonaire. N Engl J Med 1997; 337: 663-9.
• 19 Quinlan DJ, McQuillan A, Eikelboom JW. Lowmolecular-weight heparin compared with intravenous unfractionated heparin for treatment of pulmonary embolism: a meta-analysis of randomized, controlled trials. Ann Intern Med 2004; 140: 175-83.
• 20 Alpert JS, Smith R, Carlson J. et al. Mortality in patients treated for pulmonary embolism. J Am Med Assoc 1976; 236: 1477-80.
• 21 Kasper W, Konstantinides S, Geibel A. et al. Management strategies and determinants of outcome in acute major pulmonary embolism: results of a multicenter registry. J Am Coll Cardiol 1997; 30: 1165-71.
• 22 Ribeiro A, Lindmarker P, Juhlin-Dannfelt A. et al. Echocardiography Doppler in pulmonary embolism: right ventricular dysfunction as a predictor of mortality rate. Am Heart J 1997; 134: 479-87.
• 23 Pruszczyk P, Bochowicz A, Torbicki A. et al. Cardiac troponinT monitoring identifies high-risk group of normotensive patients with acute pulmonary embolism. Chest 2003; 123: 1947-52.
• 24 Pruszczyk P, Kostrubiec M, Bochowicz A. et al. N-terminal pro-brain natriuretic peptide in patients with acute pulmonary embolism. Eur Respir J 2003; 22: 649-53.
• 25 Binder L, Pieske B, Olschewski M. et al. N-terminal pro-brain natriuretic peptide or troponin testing followed by echocardiography for risk stratification of acute pulmonary embolism. Circulation 2005; 112: 1573-9.
• 26 No authors listed Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur HeartJ 2000; 21: 1301-36.
• 27 Dong B, Jirong Y, Liu G, Wang Q, Wu T. Thrombolytic treatment for pulmonary embolism. Cochrane Database System Rev. 2006 02. Art. No.:CD004437. pub2. doi:10. 1002/14651858.CD004437.pub2.
• 28 Vieillard-Baron A, Page B, Augarde R. et al. Acute cor pulmonale in massive pulmonary embolism: incidence, echocardiographic pattern, clinical implications and recovery rate. Intensive Care Med 2001; 27: 1481-6.
• 29 Kucher N, Rossi E, De Rosa M. et al. Massive pulmonary embolism. Circulation 2006; 113: 577-82.
• 30 Giannitsis E, Muller-Bardorff M, Kurowski V. et al. Independent prognostic value of cardiac troponin T in patients with confirmed pulmonary embolism. Circulation 2000; 102: 211-7.
• 31 Grifoni S, Olivotto I, Cecchini P. et al. Short-term clinical outcome of patients with acute pulmonary embolism, normal blood pressure, and echocardiographic right ventricular dysfunction. Circulation 2000; 101: 2817-22.
• 32 Konstantinides S, Geibel A, Olschewski M. et al. Association between thrombolytic treatment and the prognosis of hemodynamically stable patients with major pulmonary embolism: results of a multicenter registry. Circulation 1997; 96: 882-8.
• 33 Hamel E, Pacouret G, Vincentelli D. et al. Thrombolysis or heparin therapy in massive pulmonary embolism with right ventricular dilation: results from a 128-patient monocenter registry. Chest 2001; 120: 120-5.
• 34 Kucher N, Printzen G, Goldhaber SZ. Prognostic role of brain natriuretic peptide in acute pulmonary embolism. Circulation 2003; 107: 2545-7.
• 35 Dalla-Volta S, Palla A, Santolicandro A. et al. PAIMS 2: alteplase combined with heparin versus heparin in the treatment of acute pulmonary embolism. Plasminogen activator Italian multicenter study 2. J Am Coll Cardiol 1992; 20: 520-6.
• 36 The urokinase pulmonary embolism trial. A national cooperative study. Circulation 1973; 47: II1-108.
• 37 Goldhaber SZ, Haire WD, Feldstein ML. et al. Alteplase versus heparin in acute pulmonary embolism: randomised trial assessing right-ventricular function and pulmonary perfusion. Lancet 1993; 341: 507-11.
• 38 Kanter DS, Mikkola KM, Patel SR. et al. Thrombolytic therapy for pulmonary embolism. Frequency of intracranial hemorrhage and associated risk factors. Chest 1997; 111: 1241-5.
• 39 Mikkola KM, Patel SR, Parker JA. et al. Increasing age is a major risk factor for hemorrhagic complications after pulmonary embolism thrombolysis. Am Heart J 1997; 134: 69-72.
• 40 Meyer G, Gisselbrecht M, Diehl JL. et al. Incidence and predictors of major hemorrhagic complications from thrombolytic therapy in patients with massive pulmonary embolism. Am J Med 1998; 105: 472-7.
• 41 Jerjes-Sanchez C, Ramirez-Rivera A, de Lourdes MGarcia. et al. Streptokinase and heparin versus heparin alone in massive pulmonary embolism: a randomized controlled trial. J Thromb Thrombolysis 1995; 02: 227-9.
• 42 Konstantinides S, Geibel A, Heusel G. et al. Heparin plus alteplase compared with heparin alone in patients with submassive pulmonary embolism. N Engl J Med 2002; 347: 1143-50.
• 43 Konstantinides S. Thrombolysis in submassive pulmonary embolism? Yes. J Thromb Haemost 2003; 01: 1127-9.
• 44 Dalen JE. Thrombolysis in submassive pulmonary embolism?. No.J Thromb Haemost 2003; 01: 1130-2.
• 45 Urokinase-streptokinase embolism trial Phase 2 results. A cooperative study. J Am Med Assoc 1974; 229: 1606-13.
• 46 The UKEP study: multicentre clinical trial on two local regimens of urokinase in massive pulmonary embolism. The UKEP Study Research Group. Eur Heart J 1987; 08: 2-10.
• 47 Goldhaber SZ, Kessler CM, Heit J. et al. Randomised controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 1988; 02: 293-8.
• 48 Meyer G, Sors H, Charbonnier B. et al. Effects of intravenous urokinase versus alteplase on total pulmonary resistance in acute massive pulmonary embolism: a European multicenter double-blind trial. The European Cooperative Study Group for Pulmonary Embolism. J Am Coll Cardiol 1992; 19: 239-45.
• 49 Goldhabert SZ, Kessler CM, Heit JA. et al. Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial. J Am Coll Cardiol 1992; 20: 24-30.
• 50 Meneveau N, Schiele F, Metz D. et al. Comparative efficacy ofa two-hour regimen of streptokinase versus alteplase in acute massive pulmonary embolism: immediate clinical and hemodynamic outcome and oneyear follow-up. J Am Coll Cardiol 1998; 31: 1057-63.
• 51 Meneveau N, Schiele F, Vuillemenot A. et al. Streptokinase vs alteplase in massive pulmonary embolism. A randomized trial assessing right heart haemodynamics and pulmonary vascular obstruction. Eur Heart J 1997; 18: 1141-8.
• 52 Goldhaber SZ, Agnelli G, Levine MN. Reduced dose bolus alteplase vs conventional alteplase infusion for pulmonary embolism thrombolysis. An international multicenter randomized trial. The Bolus Alteplase Pulmonary Embolism Group. Chest 1994; 106: 718-24.
• 53 Sors H, Pacouret G, Azarian R. et al. Hemodynamic effects of bolus vs 2-h infusion of alteplase in acute massive pulmonary embolism. A randomized controlled multicenter trial. Chest 1994; 106: 712-7.
• 54 Hann CL, Streiff MB. The role of vena caval filters in the management of venous thromboembolism. Blood Rev 2005; 19: 179-202.
• 55 Mobin-Uddin K, McLean R, Jude JR. A new catheter technique of interruption of inferior vena cava for prevention of pulmonary embolism. Am Surg 1969; 35: 889-94.
• 56 Greenfield LJ, McCurdy JR, Brown PP. et al. A new intracaval filter permitting continued flow and resolution of emboli. Surgery 1973; 73: 599-606.
• 57 Girard P, Tardy B, Decousus H. Inferior vena cava interruption: how and when?. Annu Rev Med 2000; 51: 1-15.
• 58 Athanasoulis CA, Kaufman JA, Halpern EF. et al. Inferior vena caval filters: review of a 26-year singlecenter clinical experience. Radiology 2000; 216: 54-66.
• 59 Goldhaber SZ, Tapson VF. DVT FREE Steering Committee. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-62.
• 60 Mismetti P, Rivron-Guillot K, Quenet S. et al. A prospective long-term study of 220 patients with a retrievable vena cava filter for secondary prevention of venous thromboembolism. Chest. 2006 in press.
• 61 Decousus H, Leizorovicz A, Parent F. et al. A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis. Prevention du Risque d’Embolie Pulmonaire par Interruption Cave Study Group. N Engl J Med 1998; 338: 409-15.
• 62 The PREPIC Study Group. Eight-year follow-up of patients with permanent vena cava filters in the prevention of pulmonary embolism: the PREPIC (Prevention du Risque d’Embolie Pulmonaire par Interruption Cave) randomized study. Circulation 2005; 112: 416-22.
• 63 Ansell J. Vena cava filters. Do we know all that we need to know?. Circulation 2005; 112: 298-9.
• 64 Greenfield LJ. Mechanical devices and embolectomy. In: Hemostasis and Thrombosis. Basic principles and clinical practice. Lippincott: Williams and Wilkins; 2006: 1331-8.
• 65 Meyer G, Tamisier D, Sors H. et al. Pulmonary embolectomy: a 20-year experience at one center. Ann Thorac Surg 1991; 05: 232-6.
• 66 Yalamanchili K, Fleisher AG, Lehrman SG. et al. Open pulmonary embolectomy for treatment of major pulmonary embolism. Ann Thorac Surg 2004; 77: 819-23.
• 67 Timsit JF, Reynaud P, Meyer G. et al. Pulmonary embolectomy by catheter device in massive pulmonary embolism. Chest 1991; 100: 655-8.