Catheter-directed thrombolysis for iliofemoral deep vein thrombosis: helpful or hurtful?

Iliofemoral deep vein thrombosis (IFDVT) represents a clinically important subset of patients with acute DVT and identifies those who are most likely to have the most severe postthrombotic syndrome (PTS). Anticoagulation is the therapy for most with acute DVT, although those with IFDVT have benefited from strategies of thrombus removal. Current information suggests that elimination of thrombus reduces PTS by restoring patency and potentially preserving valvular function. Observational studies suggest that elimination of thrombus reduces recurrence. Retrospective studies, observational data, cohort-controlled studies and randomized trials support a strategy of thrombus removal for patients with IFDVT. The largest randomized trial to date of catheter-directed thrombolysis versus anticoagulation, the ATTRACT trial, has just completed enrollment. The primary endpoint is PTS at 2 years. Data from ATTRACT are likely to have a major impact on patient care. Until then, available information supports the use of catheter-directed thrombolysis for IFDVT.