Background
Patients undergoing administration of thrombolytic therapy for deep venous thrombosis (DVT) have been reported to have major bleeding rates of 5%–10%. These results stem from older data with dosing of thrombolytic agents extrapolated from the treatment of arterial thrombosis which in our opinion is excessive and outdated. We report our experience with the delivery of regional thrombolytic therapy as an adjunctive modality in percutaneous endovenous intervention (PEVI) for the treatment of DVT and explore its safety and efficacy.
Methods
Over a 38-month period, 412 patients with proximal DVT underwent administration of thrombolytic therapy as part of PEVI. Tissue plasminogen activator (tPA) was administered to all patients through an infusion catheter at 1 mg/kg for 18–24 h. During tPA infusion, heparin was given at 8–12 U/kg/h. Percutaneous endovenous intervention was performed on full anticoagulation. Twenty-seven percent of patients were on Coumadin with therapeutic international normalized ratio (INR), and 7% had an INR of >3. Major bleeding was defined as a drop of hemoglobin (Hb) >3g/dl, need for transfusion or a central nervous system bleed. All procedures were done under ultrasound guidance. Access site was the popliteal vein in 399 patients, internal jugular vein in 4 and iliac vein in 9. Seventy-four percent of patients received an optional inferior vena cava filter.
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