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Anticoagulants

Pharmacomechanical therapy does not lower long-term risks in DVT

A study in The New England Journal of Medicine has shown no significant difference in results following pharmacomechanical therapy for deep-vein thrombosis

Coloured angiograms (X-rays) taken from the front (left) and side (right) of a leg showing deep vein thrombosis in the calf

Source: St Bartholomew’s Hospital / Science Photo Library

Researchers carried out a randomised controlled trial to assess whether pharmacomechanical thrombolysis could help prevent post-thrombotic syndrome in patients with acute proximal deep-vein thrombosis

Complications from deep-vein thrombosis (DVT), known as post-thrombotic syndrome, occur in around half of all patients, despite the use of anticoagulant therapy. Recent studies have indicated that pharmacomechanical thrombolysis could reduce the risk.

In a study in The New England Journal of Medicine (7 December 2017), researchers randomly assigned 692 patients with acute proximal DVT to anticoagulation alone or anticoagulation plus pharmacomechanical thrombolysis[1]. This involved delivery of recombinant tissue plasminogen activator directly into the thrombus, followed by aspiration, with or without stenting.

Between 6 and 24 months, there was no significant difference in the rate of post-thrombotic syndrome between the control and pharmacomechanical thrombolysis groups, at 48% and 47%, respectively. But those undergoing pharmacomechanical thrombolysis had more major bleeding events in the first 10 days (1.7% vs 0.3%).

The researchers said the findings indicated that the limited benefits of pharmacomechanical thrombolysis do not justify the risks. Further analysis will determine if particular subgroups of patients may have achieved benefit from the treatment.

Citation: Clinical Pharmacist DOI: 10.1211/CP.2018.20204210

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Supplementary images

  • Coloured angiograms (X-rays) taken from the front (left) and side (right) of a leg showing deep vein thrombosis in the calf

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