According to research published in Frontiers in Cardiovascular Medicine, catheter-directed thrombolysis (CDT) with catheter-directed thrombectomy and additional stenting of residual stenotic lesions appears to be safe and effective in patients with postpartum iliofemoral deep venous thrombosis (DVT).
Researchers conducted a nonexhaustive literature review to evaluate safety outcomes of CDT in the peri- and postpartum period. They searched the PubMed database for studies including the terms “peripartum,” “postpartum,” or “pregnancy” and “thrombolysis.”
The team found 26 reports on either single patients or small patient series. In total, the reports included 31 patients who had been treated with CDT in the postpartum period. They did not find any large patient series or randomized controlled trials.
The mean patient age was 26.9 years (range, 20-42). The time from delivery to thrombolysis ranged from 2 to 42 days. In a single case, thrombolysis was started during pregnancy (9th gestational week).
The researchers found that the most frequently used thrombolytic agent was alteplase (15 cases, 48%), followed by urokinase (12 cases, 38%), and streptokinase (5 cases, 16%). The duration of the thrombolytic therapy ranged from 20 to 30 hours (h) for alteplase, 16 to 72 h for urokinase, and 106 to 140 h for streptokinase. Dose varied for alteplase from 0.01 mg/kg/h to 1 mg/kg/h, and a dose of 100,000 U/h was predominantly used for streptokinase and urokinase. Most patients were administered simultaneous unfractionated heparin treatment; in 4 cases, the information on adjunctive anticoagulation was missing.
Of the 31 patients included in the study, treatment was successful (<30% residual luminal area narrowing) for 22 patients (71%) and partially successful for 3 patients (10%). The outcome was not described in 6 cases. Balloon angioplasty was performed in 18 cases (58%), with stent placement in 10 cases (32%). Thrombolytic therapy was the only treatment in 3 cases. In 10 cases, adjunctive therapies (besides thrombolysis) were not described.
The researchers found no reports of major or life-threatening bleeding complications. Minor bleedings occurred in 5 cases. Some reports described other complications, including anemia, thrombocytopenia, and hemolysis, but no life-threatening situations. Of 15 cases with information reported on postthrombotic syndrome (PTS), 1 patient showed signs of mild PTS; the other 14 patients did not develop PTS.
“In conclusion, CDT together with catheter-directed thrombectomy and additional stenting of residual stenotic lesions is effective and safe in postpartum patients with iliofemoral DVT,” wrote the researchers. “So far, encouraging case reports from the literature have not documented major bleeding complications during CDT > 2 days postpartum.”
Girona M, Säly C, Makaloski V, Baumgartner I, Schindewolf M. Catheter-directed thrombolysis for postpartum deep venous thrombosis. Front Cardiovasc Med. Published online April 26, 2022. doi:10.3389/fcvm.2022.814057