Ambulatory treatment of deep vein thrombosis (pp., 73-96)
Authors: (Mehmet Kurtoglu)
Abstract: Various options are available for the treatment of deep vein thrombosis (DVT) while the natural course of the disease without intervention results in 30% pulmonary embolus and 10% mortality.
Despite the evident consensus on the high efficacy of anticoagulant and thrombolytic treatments in the prevention of pulmonary embolus in the scientific era, these treatment options are known to be less effective in the prevention of post-thrombotic syndrome (PTS) which is another potential complication. In this respect, thrombolytic treatment has become the main therapeutic option recommended for ilio-femoral DVT which has been considered associated with higher PTS possibility. However, since the past clinical trials on ambulatory conservative anticoagulant treatment were based on the old literature during the former
decade, comparison of this treatment with the recent thrombolytic treatment approach seems to be neither reasonable nor appropriate. Furthermore, there are no randomized clinical trials concerning the direct comparison of thrombolytic and anticoagulant treatments as of yet. Attractive trial results will be published soon but they may also not be able to answer all of the questions.
In this regard, we performed a clinical multi-center study based on an 18-month follow-up of 250 patients in order to evaluate the clinical outcome of neglected ambulatory conservative treatment in detail. According to the results of this study, conservative treatment was determined to be an effective and successful treatment alternative, associated with high total re-canalization ratios reaching 80%, especially in ilio-femoral DVT. When considered in terms of PTS, conservative treatment was also associated with high patient satisfaction with respect to complaints of the patients. For these reasons, we declare conventional conservative treatment to be the most ideal alternative in consensus meeting having level of evidence 1A with comparable and even preferable results in terms of better cost-effectiveness to thrombolytic treatment.