St. George's Vascular Institute, St. George's Hospital NHS Trust, Blackshaw Road, London SW17 OQT, United Kingdom.
Arterioscler Thromb Vasc Biol. 2010 Apr;30(4):669-74. doi: 10.1161/ATVBAHA.109.200766.
Deep vein thromboses (DVTs) cause significant morbidity and mortality in the general population. Oral anticoagulation therapy may reduce thrombus propagation but does not cause clot lysis and therefore does not prevent postthrombotic syndrome (PTS). Catheter-directed thrombolysis (CDT) can be used to treat DVTs as an adjunct to medical therapy, but there is no consensus defining exact indications. Current evidence suggests that CDT can reduce clot burden and DVT recurrence and consequently prevents the formation of PTS compared with systemic anticoagulation. Appropriate indications include younger individuals with acute proximal thromboses, a long life expectancy, and relatively few comorbidities. Limb-threatening thromboses may also be treated with CDT, although the subsequent mortality remains high. A number of randomized controlled trials are currently under way comparing the longer-term outcomes of CDT compared with anticoagulation alone. Initial reports suggest that venous patency and valvular function are better maintained after CDT. The effectiveness of combined pharmacomechanical thrombectomy and the role of vena cava filters need to be investigated further before strong recommendations can be made. The reported short-term outcomes following catheter-based intervention for DVT are encouraging in selected patients. Further evidence is required to establish long-term benefits and cost-effectiveness.
深静脉血栓形成（DVT）在普通人群中会导致显著的发病率和死亡率。口服抗凝治疗可能会减少血栓的蔓延，但不会导致血栓溶解，因此不会预防血栓后综合征（PTS）。导管溶栓（CDT）可作为辅助治疗用于治疗 DVT，但对于确切的适应证尚无共识。目前的证据表明，与全身抗凝相比，CDT 可以减少血栓负荷和 DVT 复发，从而预防 PTS 的形成。合适的适应证包括急性近端血栓形成、预期寿命长和相对较少合并症的年轻患者。肢体威胁性血栓也可以用 CDT 治疗，尽管随后的死亡率仍然很高。目前正在进行一些随机对照试验，比较 CDT 与单独抗凝的长期结果。初步报告表明，CDT 后静脉通畅性和瓣膜功能更好地维持。在可以做出强有力的建议之前，需要进一步研究联合药物机械血栓切除术的有效性和腔静脉滤器的作用。在选定的患者中，经导管干预治疗 DVT 的短期结果令人鼓舞。需要进一步的证据来确定长期的益处和成本效益。
