Deep vein thrombosis invasive therapy: Difference between revisions
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{{Deep vein thrombosis}} | {{Deep vein thrombosis}} | ||
'''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} {{Rim}} | '''Editor(s)-In-Chief:''' {{ATI}}, [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com]; {{AE}} {{Rim}} {{HK}} | ||
==Overview== | ==Overview== | ||
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===Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>=== | ===Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>=== | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
|colspan="1" style="text-align:center; background:LightCoral"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | | colspan="1" style="text-align:center; background:LightCoral" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class III]] (No Benefit) | ||
|- | |- | ||
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''1.''' Systemic fibrinolysis should not be given routinely to patients with IFDVT ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''.<nowiki>"</nowiki> | | bgcolor="LightCoral" |<nowiki>"</nowiki>'''1.''' Systemic fibrinolysis should not be given routinely to patients with IFDVT ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: A]])''.<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LightCoral"|<nowiki>"</nowiki>'''2.''' CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | | bgcolor="LightCoral" |<nowiki>"</nowiki>'''2.''' CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | ||
|} | |} | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen" |[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' CDT or PCDT should be given to patients with IFDVT associated with limb-threatening circulatory compromise (ie, phlegmasia cerulea dolens) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | | bgcolor="LightGreen" |<nowiki>"</nowiki>'''1.''' CDT or PCDT should be given to patients with IFDVT associated with limb-threatening circulatory compromise (ie, phlegmasia cerulea dolens) ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''2.''' Patients with IFDVT at centers that lack endovascular thrombolysis should be considered for transfer to a center with this expertise if indications for endovascular thrombolysis are present ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | | bgcolor="LightGreen" |<nowiki>"</nowiki>'''2.''' Patients with IFDVT at centers that lack endovascular thrombolysis should be considered for transfer to a center with this expertise if indications for endovascular thrombolysis are present ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | ||
|} | |} | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' CDT or PCDT is reasonable for patients with IFDVT associated with rapid thrombus extension despite anticoagulation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' and/or symptomatic deterioration from the IFDVT despite anticoagulation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' CDT or PCDT is reasonable for patients with IFDVT associated with rapid thrombus extension despite anticoagulation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' and/or symptomatic deterioration from the IFDVT despite anticoagulation ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' CDT or PCDT is reasonable as first-line treatment of patients with acute IFDVT to prevent PTS in selected patients at low risk of bleeding complications ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' CDT or PCDT is reasonable as first-line treatment of patients with acute IFDVT to prevent PTS in selected patients at low risk of bleeding complications ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: B]])''.<nowiki>"</nowiki> | ||
|} | |} | ||
===Recommendations for Percutaneous Transluminal Venous Angioplasty and Stenting (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>=== | ===Recommendations for Percutaneous Transluminal Venous Angioplasty and Stenting (DO NOT EDIT)<ref name="pmid21422387">{{cite journal|author=Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ et al.| title=Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association. | journal=Circulation | year= 2011 | volume= 123 | issue= 16 | pages= 1788-830 |pmid=21422387 | doi=10.1161/CIR.0b013e318214914f| pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21422387 }} </ref>=== | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | | colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIa]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' Stent placement in the iliac vein to treat obstructive lesions after CDT, PCDT, or surgical venous thrombectomy is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' Stent placement in the iliac vein to treat obstructive lesions after CDT, PCDT, or surgical venous thrombectomy is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''2.''' For isolated obstructive lesions in the common femoral vein, a trial of percutaneous transluminal angioplasty without stenting is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' For isolated obstructive lesions in the common femoral vein, a trial of percutaneous transluminal angioplasty without stenting is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''.<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''3.''' The placement of iliac vein stents to reduce PTS symptoms and heal venous ulcers in patients with advanced PTS and iliac vein obstruction is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''3.''' The placement of iliac vein stents to reduce PTS symptoms and heal venous ulcers in patients with advanced PTS and iliac vein obstruction is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''4.''' After venous stent placement, the use of therapeutic anticoagulation with similar dosing, monitoring, and duration as for IFDVT patients without stents is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''4.''' After venous stent placement, the use of therapeutic anticoagulation with similar dosing, monitoring, and duration as for IFDVT patients without stents is reasonable ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])''<nowiki>"</nowiki> | ||
|} | |} | ||
{|class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LemonChiffon"| [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | | colspan="1" style="text-align:center; background:LemonChiffon" | [[ACC AHA guidelines classification scheme#Classification of Recommendations|Class IIb]] | ||
|- | |- | ||
|bgcolor="LemonChiffon"|<nowiki>"</nowiki>'''1.''' After venous stent placement, the use of antiplatelet therapy with concomitant anticoagulation in patients perceived to be at high risk of rethrombosis may be considered ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | | bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' After venous stent placement, the use of antiplatelet therapy with concomitant anticoagulation in patients perceived to be at high risk of rethrombosis may be considered ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | ||
|} | |||
== 2016 American College of Chest Physicians Guidelines For Management of Venous thromboembolism (VTE) == | |||
=== Recommendations for Catheter Directed Thrombolysis (CDT) in Acute PE === | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" |'''Grade 2C''' | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' In patients with acute PE associated with hypotension and who have (i) a high bleeding risk, (ii) failed systemic thrombolysis, or (iii) shock that is likely to cause death before systemic thrombolysis can take effect (eg, within hours), if appropriate expertise and resources are available catheter-assisted thrombus removal (with or without catheter directed thrombolysis) is recommended over no such intervention)''.<nowiki>"</nowiki> | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''2.''' In patients with acute PE who are treated with a thrombolytic agent, systemic thrombolytic therapy using a peripheral vein is recommended over CDT''.<nowiki>"</nowiki> | |||
|} | |||
=== Recommendations for Catheter Directed Thrombolysis (CDT) in Acute DVT === | |||
{| class="wikitable" | |||
|- | |||
| colspan="1" style="text-align:center; background:LemonChiffon" |'''Grade 2C''' | |||
|- | |||
| bgcolor="LemonChiffon" |<nowiki>"</nowiki>'''1.''' In patients with acute proximal DVT of the leg, anticoagulant therapy alone is recommended over CDT''.<nowiki>"</nowiki> | |||
|} | |} | ||
Latest revision as of 01:16, 11 October 2018
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Editor(s)-In-Chief: The APEX Trial Investigators, C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2] Syed Hassan A. Kazmi BSc, MD [3]
Overview
Catheter directed thrombolysis (CDT) and pharmacomechanical catheter directed thrombolysis (PCDT) are indicated for the treatment of limb threatening cases of iliofemoral deep vein thrombosis (IFDVT). Stent placement in the iliac veins can be considered for the treatment of obstructive lesions following CDT and PCDT. Stent placement can also be considered to attenuate symptoms of severe post thrombotic syndrome associated with iliac vein obstruction.
2011 AHA Scientific Statement-Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension (DO NOT EDIT)[1]
Recommendations for Endovascular Thrombolysis and Surgical Venous Thrombectomy (DO NOT EDIT)[1]
| Class III (No Benefit) |
| "1. Systemic fibrinolysis should not be given routinely to patients with IFDVT (Level of Evidence: A)." |
| "2. CDT or PCDT should not be given to most patients with chronic DVT symptoms (>21 days) or patients who are at high risk for bleeding complications (Level of Evidence: B)." |
| Class I |
| "1. CDT or PCDT should be given to patients with IFDVT associated with limb-threatening circulatory compromise (ie, phlegmasia cerulea dolens) (Level of Evidence: C)." |
| "2. Patients with IFDVT at centers that lack endovascular thrombolysis should be considered for transfer to a center with this expertise if indications for endovascular thrombolysis are present (Level of Evidence: C)." |
| Class IIa |
| "1. CDT or PCDT is reasonable for patients with IFDVT associated with rapid thrombus extension despite anticoagulation (Level of Evidence: C) and/or symptomatic deterioration from the IFDVT despite anticoagulation (Level of Evidence: B)." |
| "2. CDT or PCDT is reasonable as first-line treatment of patients with acute IFDVT to prevent PTS in selected patients at low risk of bleeding complications (Level of Evidence: B)." |
Recommendations for Percutaneous Transluminal Venous Angioplasty and Stenting (DO NOT EDIT)[1]
| Class IIa |
| "1. Stent placement in the iliac vein to treat obstructive lesions after CDT, PCDT, or surgical venous thrombectomy is reasonable (Level of Evidence: C)." |
| "2. For isolated obstructive lesions in the common femoral vein, a trial of percutaneous transluminal angioplasty without stenting is reasonable (Level of Evidence: C)." |
| "3. The placement of iliac vein stents to reduce PTS symptoms and heal venous ulcers in patients with advanced PTS and iliac vein obstruction is reasonable (Level of Evidence: C)" |
| "4. After venous stent placement, the use of therapeutic anticoagulation with similar dosing, monitoring, and duration as for IFDVT patients without stents is reasonable (Level of Evidence: C)" |
| Class IIb |
| "1. After venous stent placement, the use of antiplatelet therapy with concomitant anticoagulation in patients perceived to be at high risk of rethrombosis may be considered (Level of Evidence: C) " |
2016 American College of Chest Physicians Guidelines For Management of Venous thromboembolism (VTE)
Recommendations for Catheter Directed Thrombolysis (CDT) in Acute PE
| Grade 2C |
| "1. In patients with acute PE associated with hypotension and who have (i) a high bleeding risk, (ii) failed systemic thrombolysis, or (iii) shock that is likely to cause death before systemic thrombolysis can take effect (eg, within hours), if appropriate expertise and resources are available catheter-assisted thrombus removal (with or without catheter directed thrombolysis) is recommended over no such intervention)." |
| "2. In patients with acute PE who are treated with a thrombolytic agent, systemic thrombolytic therapy using a peripheral vein is recommended over CDT." |
Recommendations for Catheter Directed Thrombolysis (CDT) in Acute DVT
| Grade 2C |
| "1. In patients with acute proximal DVT of the leg, anticoagulant therapy alone is recommended over CDT." |
References
- ↑ 1.0 1.1 1.2 Jaff MR, McMurtry MS, Archer SL, Cushman M, Goldenberg N, Goldhaber SZ; et al. (2011). "Management of massive and submassive pulmonary embolism, iliofemoral deep vein thrombosis, and chronic thromboembolic pulmonary hypertension: a scientific statement from the American Heart Association". Circulation. 123 (16): 1788–830. doi:10.1161/CIR.0b013e318214914f. PMID 21422387.