Local and systemic thrombolytic therapy for acute venous thromboembolism.

摘要: Thrombolytic therapy unquestionably leads to more rapid and complete clot lysis with a significantly higher risk of bleeding when compared anticoagulation. The most definite indication for thrombolytic in patients VTE is massive PE associated hemodynamic instability. Other potential indications, although not widely accepted or proven, include PE-related respiratory failure severe hypoxemia iliofemoral thrombosis the phlegmasia cerulea dolens. Routine use all other cases DVT cannot be justified. Future research using randomized controlled studies should focus on following key questions: Do hemodynamically stable right ventricular dysfunction benefit from thrombolysis, and, if so, there subset within this group who are likely benefit? Does improve long-term outcomes favorable risk-to-benefit ratio, which long-term? What precise role catheter-directed thrombolysis treatment VTE, particularly low-dose agent conjunction mechanical disruption minimize at high risk? Until these questions answered, clinicians must approach decision-making regarding careful consideration risks benefits patient framework currently available data.