Comerota Anthony J
INOVA ALEXANDRIA HOSPITAL, ALEXANDRIA, VIRGINIA.
Methodist Debakey Cardiovasc J. 2018 Jul-Sep;14(3):219-227. doi: 10.14797/mdcj-14-3-219.
Systemically delivered pharmacologic thrombolysis for acute deep vein thrombosis long ago gave way to catheter delivery of plasminogen activators within the clot. This simple concept resulted in markedly improved efficacy and safety. In an effort to accelerate thrombus dissolution or extraction, mechanical methods were developed, but the initial techniques left substantial residual thrombus that required subsequent catheter-directed thrombolysis (CDT). It was soon observed that combined pharmacomechanical thrombolysis was more effective than either one alone. Randomized trials of catheter-based strategies for thrombus removal have documented objective benefit, including improved patency, preserved valve function, and reduced post-thrombotic syndrome. The largest randomized study is the ATTRACT trial published at the end of 2017. Although mild post-thrombotic syndrome (PTS) was no different between the pharmacomechanical catheter-directed thrombolysis (PCDT) and control groups, acute pain and swelling and moderate-to-severe PTS were reduced with PCDT. Additional analyses from this robust data set are forthcoming.
很久以前，用于急性深静脉血栓形成的全身给药药理学溶栓已被在血栓内导管输送纤溶酶原激活剂所取代。这个简单的概念带来了疗效和安全性的显著提高。为了加速血栓溶解或清除，人们开发了机械方法，但最初的技术留下了大量残余血栓，需要随后进行导管直接溶栓（CDT）。很快人们就发现，联合药物机械溶栓比单独使用任何一种方法都更有效。基于导管的血栓清除策略的随机试验已证明有客观益处，包括改善通畅性、保留瓣膜功能和减少血栓形成后综合征。最大的随机研究是2017年底发表的ATTRACT试验。虽然药物机械导管直接溶栓（PCDT）组和对照组之间轻度血栓形成后综合征（PTS）没有差异，但PCDT可减轻急性疼痛和肿胀以及中度至重度PTS。来自这个丰富数据集的更多分析即将推出。
