Alesh Issa, Kayali Fadi, Stein Paul D
Department of Research, St. Joseph Mercy-Oakland Hospital, Pontiac, Michigan, USA.
Catheter Cardiovasc Interv. 2007 Jul 1;70(1):143-8. doi: 10.1002/ccd.21079.
Methods of delivery of thrombolytic agents for massive or limb threatening deep venous thrombosis (DVT) include a systemic infusion, local-regional administration, and catheter-directed therapy (tip of catheter placed inside the thrombus). We evaluated the effectiveness of catheter-directed therapy and compared the results with randomized clinical trials of systemic and local-regional thrombolytic therapy. Many who used catheter-directed thrombolysis used balloon angioplasty, stents, or thrombectomy in addition. Pooled data showed higher rates of complete early opening of occluded veins with catheter-directed thrombolysis alone, 90%, or with catheter-directed thrombolysis often followed by adjunct therapy, 76%, than with a systemic infusion, 28%, or local-regional administration, 20%. The prevalence of postthrombotic syndrome was lower with catheter-directed combined with adjunct therapy, 26%, compared with 56% and 69%, respectively. Rates of any bleeding were higher with catheter-directed thrombolytic therapy, but bleeding was usually minor. In conclusion, the data suggest that catheter-directed thrombolytic therapy may be more beneficial than systemic or local regional administration. An advantage is that it lends itself to adjunct treatment following the administration of thrombolytic agents if the thrombolysis is inadequate.
用于大面积或威胁肢体的深静脉血栓形成（DVT）的溶栓药物给药方法包括全身输注、局部区域给药和导管定向治疗（将导管尖端置于血栓内）。我们评估了导管定向治疗的有效性，并将结果与全身和局部区域溶栓治疗的随机临床试验进行了比较。许多采用导管定向溶栓的人还会另外使用球囊血管成形术、支架或血栓切除术。汇总数据显示，单独使用导管定向溶栓时，闭塞静脉早期完全开通率为90%，导管定向溶栓后常辅以辅助治疗时，闭塞静脉早期完全开通率为76%，高于全身输注时的28%或局部区域给药时的20%。与分别为56%和69%相比，导管定向联合辅助治疗时血栓形成后综合征的患病率较低，为26%。导管定向溶栓治疗时任何出血的发生率较高，但出血通常较轻微。总之，数据表明导管定向溶栓治疗可能比全身或局部区域给药更有益。一个优点是，如果溶栓不充分，在给予溶栓药物后它便于进行辅助治疗。
