Catheter-Directed Thrombolysis Is a Safe and Alternative Therapeutic Approach in the Management of Postpartum Lower Limb Deep Venous Thrombosis

Abstract

Deep vein thrombosis (DVT) is a major health problem in pregnancy and postpartum period. Catheter-directed thrombolysis (CDT) is safe and effective in management of symptomatic DVT. Value of CDT in postpartum DVT is not fully evaluated. We describe five patients presenting with acute iliofemoral DVT in their early postpartum period who were treated with mechanical thromboaspiration and CDT. The CDT was done using streptokinase infusion and unfractionated heparin. Percutaneous angioplasty was done in patients with symptomatic residual lesion following thrombolysis. Patients were discharged with oral anticoagulant and compression stockings. This approach was successful in all four cases. Percutaneous endovascular therapy using CDT, mechanical thromboaspiration, and balloon angioplasty is safe and effective in iliofemoral DVT in postpartum period.

Keywords

angioplasty - catheter-directed thrombolysis - deep vein thrombosis - mechanical thromboaspiration - postpartum

• References

• 1 Ray JG, Chan WS. Deep vein thrombosis during pregnancy and the puerperium: a meta-analysis of the period of risk and the leg of presentation. Obstet Gynecol Surv 1999; 54 (4) 265-271
• 2 O'Connor DJ, Scher LA, Gargiulo III NJ, Jang J, Suggs WD, Lipsitz EC. Incidence and characteristics of venous thromboembolic disease during pregnancy and the postnatal period: a contemporary series. Ann Vasc Surg 2011; 25 (1) 9-14
• 3 Jacobsen AF, Drolsum A, Klow NE, Dahl GF, Qvigstad E, Sandset PM. Deep vein thrombosis after elective cesarean section. Thromb Res 2004; 113 (5) 283-288
• 4 Acharya G, Singh K, Hansen JB, Kumar S, Maltau JM. Catheter-directed thrombolysis for the management of postpartum deep venous thrombosis. Acta Obstet Gynecol Scand 2005; 84 (2) 155-158
• 5 Gader AA, Haggaz AE, Adam I. Epidemiology of deep venous thrombosis during pregnancy and puerperium in Sudanese women. Vasc Health Risk Manag 2009; 5 (1) 85-87
• 6 McLintock C, Brighton T, Chunilal S , et al; Councils of the Society of Obstetric Medicine of Australia and New Zealand; Australasian Society of Thrombosis and Haemostasis. Recommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period. Aust N Z J Obstet Gynaecol 2012; 52 (1) 14-22
• 7 Virkus RA, Jørgensen M, Broholm R, Bergholt T. Successful treatment of massive deep vein thrombosis using catheter-directed thrombolysis and inferior vena cava filter in a puerperal woman. Acta Obstet Gynecol Scand 2012; 91 (2) 269-270
• 8 Comerota AJ. The ATTRACT trial: rationale for early intervention for iliofemoral DVT. Perspect Vasc Surg Endovasc Ther 2009; 21 (4) 221-224 , quiz 224–225
• 9 Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg 2007; 33 (3) 351-360 , discussion 361–362
• 10 Patterson BO, Hinchliffe R, Loftus IM, Thompson MM, Holt PJ. Indications for catheter-directed thrombolysis in the management of acute proximal deep venous thrombosis. Arterioscler Thromb Vasc Biol 2010; 30 (4) 669-674
• 11 Enden T, Haig Y, Kløw NE , et al; CaVenT Study Group. Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet 2012; 379 (9810) 31-38
• 12 Elsharawy M, Elzayat E. Early results of thrombolysis vs anticoagulation in iliofemoral venous thrombosis. A randomised clinical trial. Eur J Vasc Endovasc Surg 2002; 24 (3) 209-214