Deep Vein Thrombosis Treatment Guidelines Change
(posted September 22, 2008)
The American College of Chest Physicians (ACCP) recently released new guidelines for the treatment of a dangerous blood clot that can form in the legs, known as deep vein thrombosis (DVT). Each year 1 or 2 people in 1,000 develop a blood clot in the veins of their legs. If a piece of that clot breaks off and goes to the lungs, known as pulmonary embolism, 25 percent of those people die suddenly. Of those who have DVT, nearly a third suffer long-lasting effects that include leg swelling and severe pain that adversely affects quality of life.
Previously, the ACCP recommended a conservative approach for the treatment of DVT, including the use of compression stockings and anticoagulation therapy to thin patients’ blood. For patients with extensive, acute DVT, the ACCP now recommends removing the clot as completely and rapidly as possible, using a combination of a clot-busting drug and removal, a process known as pharmacomechanical thrombolysis (PMT) to shorten treatment time. This means that the ACCP is advising physicians that, in some circumstances, a more aggressive approach to clot removal than has been previously used is warranted.
The interventional radiology department at Rhode Island Hospital and The Miriam Hospital has been offering the PMT treatment since 2006.
“It is important for the community to realize that there are safe, effective options available to patients for the treatment of DVT,” said Gregory Soares, MD, director of interventional radiology at Rhode Island Hospital. “With PMT, patients can now receive the ACCP’s recommended treatment quickly and effectively, usually in a single setting, and often with a very limited hospital stay.”
Interventional radiologists at Rhode Island Hospital and The Miriam Hospital currently use a mechanical thrombectomy (clot removal) device for these procedures. Assisted by sophisticated imaging guidance, they place the device through a 2 mm size skin incision through a leg vein and into the clot. The device isolates the clot using tiny balloons, and then releases medication directly onto the clot to loosen it, before capturing and removing it as the device is withdrawn from the vein.
Performing the procedure in this way not only quickly alleviates leg symptoms but may also reduce the risk of DVT occurring again, as well as associated long-term serious health issues, such as leg swelling, pain and leg ulceration.