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Semin intervent Radiol 2022; 39(04): 394-399
DOI: 10.1055/s-0042-1757318
Review Article

A Brief Review of Thrombolytics for Venous Interventions

Sukhdeep K. Grewal   *
1   Department of Radiology and Medical Imaging, Vascular and Interventional Radiology, University of Virginia Health, Charlottesville, Virginia
,
Amanda L. Hedrick   *
2   Department of Medicine, Critical Care Pharmacology, University of Virginia Health, Charlottesville, Virginia
,
Louise Man
3   Department of Medicine, Hematology and Oncology, University of Virginia Health, Charlottesville, Virginia
,
Aditya M. Sharma
4   Department of Medicine, Cardiovascular Medicine, University of Virginia Health, Charlottesville, Virginia
,
Kush R. Desai
5   Interventional Radiology, Department of Radiology, Northwestern University, Chicago, Illinois
,
Minhaj S. Khaja
1   Department of Radiology and Medical Imaging, Vascular and Interventional Radiology, University of Virginia Health, Charlottesville, Virginia
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Abstract

Anticoagulation continues to be the mainstay of therapy for the management of venous thromboembolism. However, anticoagulation does not lead to the breakdown or dissolving of the thrombus. In an acute pulmonary embolism, extensive thrombus burden can be associated with a high risk for early decompensation, and in acute deep venous thrombosis, it can be associated with an increased risk for phlegmasia. In addition, residual thrombosis can be associated with chronic thromboembolic pulmonary hypertension and postthrombotic syndrome in a chronic setting. Thrombolytic therapy is a crucial therapeutic choice in treating venous thromboembolism for thrombus resolution. Historically, it was administered systemically and was associated with high bleeding rates, particularly major bleeding, including intracranial bleeding. In the last two decades, there has been a significant increase in catheter-based therapies with and without ultrasound, where lower doses of thrombolytic agents are utilized, potentially reducing the risk for major bleeding events and improving the odds of reducing the thrombus burden. In this article, we provide an overview of several thrombolytic therapies, including delivery methods, doses, and outcomes.

Keywords

thrombolysis - alteplase - venous thromboembolic disease - venous thromboembolism - interventional radiology

* S.K.G. and A.L.H. are co–first authors.




Publication History

Article published online:
17 November 2022

© 2022. Thieme. All rights reserved.

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