Pharmacomechanical Catheter Directed Thrombolysis for Pregnancy Related Proximal Lower Extremity Deep Venous Thrombosis: Effectiveness in the Prevention of Post Thrombotic Syndrome

Pharmacomechanical catheter-directed thrombolysis (PCDT) reduces the incidence of post thrombotic syndrome (PTS) after proximal deep vein thrombosis (DVT); however its efficacy in PTS prevention for pregnancy related DVT is unknown. Most of the patients with DVT in pregnancy present with femoral or iliofemoral involvement and the prevalence after of PTS after pregnancy related DVT in the lower extermity is 42%. The purpose of this study is to compare PTS outcome in women with pregnancy related DVT with and without PCDT.

Methods: Women with pregnancy related proximal (femoral/iliofemoral) DVT who underwent PCDT and anticoagulation or anticoagulation alone, were evaluated for PTS using the Villalta scale and VEINES-QOL/Sym questionnaire.

Results: Eleven women with iliofemoral DVT underwent PCDT and anticoagulation, two during the first trimester and nine postpartum. Eighteen women (13 with iliofemoral DVT) were treated with anticoagulation only. There was no difference in age, number of pregnancies, trimester, duration of anticoagulation or thrombophilia between the groups. The time between DVT diagnosis and study inclusion was longer in the control group - median 50.5 (range 16-120) months , compared to study group: median 27 (range 11-64) months. None of the women in the study group developed PTS. Six of 18 patients in the control group developed PTS (33.3%) P=0.03, four of whom developed severe PTS (Villalta scale ≥15). One patient in each group developed recurrent DVT, and one patient in the study group developed a calf hematoma. A reduced frequency of lower extremity symptoms was observed in the study group by VEINES-Sym questionnaire P=0.01, but there was no difference in VEINES-QOL questionnaire (p=0.11)

Conclusion: This study suggests a reduction in PTS in women with pregnancy related proximal DVT who were treated with PCDT and anticoagulation compared to women who were treated with anticoagulation alone