Post thrombotic syndrome after thrombolytic therapy- Do we have enough support for considering thrombolytic therapy?

Deep venous thrombosis (DVT) of the lower limbs can lead to post-thrombotic syndrome. There is a strong correlation between post-thrombotic syndrome and the extent of the thrombotic process. The progress of distal DVTs is benign with a high rate of recanalization and low rate of venous reflux. Persistence of chronic occlusion and venous reflux is common in extensive DVTs. The proximal DVT (upto 96%) may progress with reflux and/or venous obstruction. Venous segments with evidence of reflux after DVT recanalization were those presenting a spontaneous fibrinolysis up to 7 times longer than the observed in competent segments, suggesting that thrombus removal time is also an important factor in vein valve preservation. The use of locally infused fibrinolytic agents presents the possibility of direct intervention for immediate thrombus removal.Theoretically, this specific feature of thrombolysis should lead to immediate improvement of clinical results in extensive cases of DVT, as well as to preservation of valvular competence and venous wall morphology as has been described by experimental studies. So, we can think in favor of Thrombolytic therapy in extensive proximal DVT cases.

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