Is Catheter-Directed Thrombolysis Worthwhile in Patients with Proximal Deep Venous Thrombosis?

Within 2 years after anticoagulant therapy for proximal deep venous thrombosis (DVT), about half of patients develop postthrombotic syndrome (PTS), which might include edema, pain, hyperpigmentation, and skin breakdown. Pharmacomechanical catheter-directed thrombolysis aims to lower thrombus burden and risk for PTS by delivering a fibrinolytic drug directly into a thrombus, followed by thrombus aspiration or maceration.

Researchers randomized 691 patients with symptomatic proximal DVT to guideline-based anticoagulant therapy with or without pharmacomechanical thrombolysis. All patients were advised to use compression stockings. At 24 months, PTS (assessed using standardized scales and definitions) had developed in roughly the same percentage…