Randomized trial evidence supporting a strategy of thrombus removal for acute DVT.

Reports of strategies of thrombus removal for acute deep venous thrombosis (DVT), especially in patients with iliofemoral DVT, consistently demonstrate improved outcomes relative to postthrombotic morbidity. Randomized trials support the observation that a strategy of thrombus removal reduces postthrombotic syndrome in patients with extensive proximal DVT. Unfortunately, there have been few randomized trials to date and they do not stand up to rigorous methodological review. This results in relatively weak recommendations by national and international guidelines for treatment strategies designed to eliminate thrombus. This report reviews the outcomes of randomized studies of treatments designed to remove thrombus from the venous system, including operative venous thrombectomy, systemic thrombolysis, and catheter-directed thrombolysis. Hopefully, the reader can put these results into perspective versus those anticipated with anticoagulation alone.