Clot Lacing

Risk Free

A pilot study shows that a new treatment for blood clots in the legs is effective and risk-free. The results of this study suggest that a process of injecting a blood clot with a thrombolytic, fiber-binding chemical agent works well in treating deep vein thrombosis or DVT. Researchers call this "lacing" the clot and found that this therapy is effective in reducing the risk of bleeding and recurrence.

Fatal Complication

Lead author Richard Chang, M.D., chief of the interventional radiology section of the Department of Radiology, Clinical Center, National Institute of Health (NIH), Bethesda, Md., stated, "This treatment regimen is able to clear blood clots rapidly and safely, restoring blood flow in the veins of the lower leg, and the results are durable."

DVT is not only a common condition, but a serious one, too. In DVT, a blood clot, or thrombus takes shape inside the deep veins, most often in the lower leg or in the thigh. If the clot should break off and travel to the lungs, this can result in pulmonary embolism, a condition that can be fatal.

Standard treatment for DVT is anticoagulation therapy, such as blood thinners, along with wearing special stockings that help to compress the veins. Recent studies, however, suggest that one third of these patients develop a condition known as post-thrombotic syndrome that comes with pain, swelling, and skin changes. Yet another third of DVT patients treated with standard therapy will have a recurrence or a pulmonary embolism five years after their initial bout with DVT.

While clot-dissolving therapy may protect a patient against these complications, it poses a risk for bleeding. Due to the high rate of these complications, Dr. Chang and his colleagues worked to find a treatment that is effective, inexpensive, and safe. The research team treated twenty patients suffering from acute DVT by intraclot lacing of the thrombus with the thrombolytic or clot-dissolving agent known as alteplase along with full systemic anticoagulation. The benefit of alteplase over other agents is that it binds to the clot so that there is no need for a long term infusion of the clot-busting chemical. The radiologist can direct catheters to each affected segment of the vein so that the entire clot is given adequate treatment. It was found that alteplase is cleared from the circulatory system within two hours after the procedure. This serves to reduce the risk of post-therapy bleeding.

16 out of 20 patients or 80% of the study participants had a complete restoration of their blood supply in the deep venous system, while there was a complete resolution of symptoms in 18 patients or 90% within 6 months of anticoagulation therapy. Even better, the therapy caused no serious complications or bleeding episodes. There were no occurrences of post-thrombotic syndrome or recurrent clotting during the follow-up period of 3.4 years.

While the researchers feel that a wider study of the technique is needed to bear out the promising results of the pilot study, McDonald K. Horne III, M.D., a co-author of the study from the hematology section of the Department of Lab Medicine, Clinical Center, NIH said, "With this therapy, pain and swelling resolve rapidly, and, in most cases, the patient is able to resume all normal activity within a week."