Understanding the problem

People often ask why anticoagulants are used to treat DVT instead of thrombolytics or physical removal of the clot. There are 3 important reasons for this: (1) thrombolytics are more likely to cause serious bleeding, including intracranial hemorrhage, than anticoagulants; (2) insertion of a mechanical device into veins requires both special equipment and skills; and (3) neither of these methods have been shown to be better than anticoagulants at reducing the complications of DVT. Also, people who are given thrombolytics or receive mechanical intervention still require anticoagulants following treatment to prevent new blood clots from forming.

PTS is a long-term complication of DVT that occurs in 25-50% of patients who have a proximal DVT. PTS includes symptoms such as leg pain, itching or heaviness, along with signs such as swelling, skin discolouration, and formation of ulcers. Most people who develop PTS do so within 2 years of being diagnosed with DVT.

Researchers recently wondered if using pharmacomechanical catheter-directed thrombolysis (PCDT; thrombolytics delivered by a tube inserted into the leg vein that also contains a mechanical device that physically chews up the clot) would be better at reducing PTS than anticoagulants alone.