March 7, 2014 — Deep vein thrombosis (DVT) often brings with it the risk of post-thrombotic syndrome (PTS), an under-recognized but serious complication that often causes long-term disability for patients. During March's DVT Awareness Month, the Society of Interventional Radiology wants to help patients and family members better understand the long-term risks of DVT.
DVT is a grave condition for which doctors have historically focused on its short-term risks.
"For years, if someone developed deep vein thrombosis, his or her care was focused on reducing immediate harm using blood-thinning drugs,” said Suresh Vedantham, M.D., FSIR, an interventional radiologist and SIR service line officer. “However, the prevention of post-thrombotic syndrome, which is actually the primary determinant of a DVT patient's long-term quality of life, had been neglected. The evidence is mounting that interventional radiologists may soon transform the way we treat DVT in a way that improves patients' quality of life and prevents the debilitating consequences of post-thrombotic syndrome," said Vedantham, who is professor of radiology and surgery at Washington University School of Medicine in St. Louis, Mo.
Anticoagulants do not actively dissolve a blood clot; they just prevent new clots from forming, he explained. The body will sometimes eventually dissolve a clot, but often the vein becomes damaged. A significant proportion of DVT patients develop irreversible damage in the affected leg veins and their valves, resulting in abnormal pooling of blood in the leg, chronic leg pain, fatigue, swelling and, in extreme cases, severe skin ulcers.
"For a long time, doctors have believed that the use of compression stockings can prevent PTS; however, a rigorous study of compression stockings, published recently, shows that this is not the case," said Vedantham.
On the other hand, a randomized trial evaluating the use of clot removal with interventional catheter-directed thrombolysis found a significant reduction in PTS. That is a treatment performed by interventional radiologists who guide a catheter or specialized device into a leg vein and thread it into the vein containing the clot and a "clot-busting" drug is infused directly into the clot. Since catheter-directed thrombolysis is most effective when performed within 14 days after DVT symptoms begin, he recommends that a second opinion from an interventional radiologist be sought if leg pain and swelling continue beyond seven days after treatment is started.
"Individuals who received these treatments experienced fewer long-term symptoms and significantly less time lost from work," said Vedantham, who is also the principal investigator for the National Institutes of Health-sponsored ATTRACT Trial, the most rigorous United States-based study of these new treatments.
In light of new research, SIR will also soon be issuing revised DVT guidelines that seek to improve the quality of care patients receive. During SIR's Annual Scientific Meeting March 22–27 in San Diego, attendees will hear about venous thromboembolic disease and acute DVT care and have the opportunity to take an in-depth look at complex issues in patients suffering from superficial and deep venous disease.
For more information: www.sirweb.org