Treatment Options Pharmacologic Therapy Thrombolytics

The role of thrombolysis in the treatment of VTE is controversial. Thrombolytic agents are proteolytic enzymes that have the ability to dissolve, or lyse, the fibrin clot (Table 10-4). Thrombolytics are administered systemically or directly into the throm-

bus using a catheter-directed infusion. Compared to anticoagulants, thrombolytics restore venous patency more quickly; however, the bleeding risk associated with their

use is significantly higher. In patients with DVT, thrombolytics decrease short-term pain and swelling and prevent destruction of the venous valves. It is not clear if thrombolytics decrease the incidence and severity of PTS. Clinical trials have failed to show any long-term benefits from the routine use of thrombolytics; therefore, their use in the majority of patients is not recommended.17,25 In a select group of high-risk patients with massive iliofemoral DVT who are at risk of limb gangrene, thrombolysis 17

may be considered.

Acute phsse: 5-14 days

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