CATHETER-DIRECTED THROMBOLYSIS FOR DEEP VENOUS THROMBOSIS IN PREGNANT WOMEN AND PATIENTS WITH ACTIVE CANCER (A COMPREHENSIVE REVIEW)

  • Duarte Rego Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Gabriela Teixeira Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Daniel Mendes Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Paulo Almeida Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
  • Rui Almeida Serviço de Angiologia e Cirurgia Vascular, Centro Hospitalar Universitário do Porto
Keywords: Deep Vein Thrombosis, Thrombolytic therapy, Catheter-directed thrombolysis, Post-thrombotic syndrome, Cancer, Pregnancy

Abstract

Introduction: Post-thrombotic syndrome is associated with severely decreased quality of life and develops in up to 50% of patients with iliofemoral deep vein thrombosis (DVT) despite effective anticoagulation. Catheter-directed thrombolysis (CDT) use has become widespread and is supported by a growing body of scientific evidence (including randomized controlled trials). However, almost all of these trials have excluded two groups of patients in which DVT has a particularly increased burden: pregnant women and patients with active cancer.

Aims: This non-systematic review of literature aims to provide a comprehensive analysis of the existing evidence on the safety and efficacy of CDT for iliofemoral DVT in these subgroups of patients.

Results: Endovascular treatment of iliofemoral DVT during pregnancy and puerperium seems safe and effective both for the pregnant woman and the fetus. The risks of radiation (especially in the first trimester) must be discussed and taken in consideration.

CDT and pharmacomechanical thrombolysis (PMT) are both safe and effective in patients with active cancer, as long as metastatic brain lesions are excluded. However, effective anticoagulation (with low-molecular weight heparin or, in selected patients, direct oral anticoagulants) should be prescribed after the intervention to maintain patency in these patients with continued thrombophilia. 

Conclusions: CDT, with or without PMT, should be offered to pregnant patients and patients with active cancer provided that a careful risk-benefit assessment is made for each individual patient.

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Published
2019-05-15
Section
Review Article

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