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А вот , что думает о лечении тяжелого флеботромбоза Gerard O’Sullivan из Ирландии. Это сообщение сделано в апреле этого года на очередном издании популярнейшего CX Symposium в Лондоне
DVT patients should go to venous specialist, not emergency department
Wed 22-Apr-2009 11:38
Deep vein thrombosis (DVT) patients should no longer be going to the emergency department and obtaining heparin and warfarin that are no use to them, according to Gerard O’Sullivan, University College Hospital, Galway, Ireland.
O’Sullivan was presenting at the CX Symposium in April 2009, describing the benefits of the Trellis pharmaco-mechanical thrombectomy system (Bacchus Vascular).
"At the present time, the biggest problem is that patients are being admitted under physicians and emergency room doctors, and they think that they’re treating the patient.They’re actually treating themselves," said O’Sullivan. "They’re treating the patient in so far as they’re diminishing the risk of proximal propogation of thrombus, they may slightly diminish the risk of pulmonary embolism, but they are not treating the thrombus.
"Heparin, low-molecular-weight heparin, and warfarin do not attack the thrombus. If you’re really going to treat these patients, you need a thrombolytic, something which attacks the thrombus."
Although systemic thrombolysis and catheter-directed thrombolysis work well for specific indications, he said, both carry a high risk of bleeding, and are heavily time- and resource-consuming.
"Over the past ten years there’s been shift towards using pharmaco-mechanical thrombectomy, which, in the case of Trellis, is a combination of catheter-directed thrombolysis isolated to one position, as well as mechanical dispersion."
He said that most acute DVT patients presenting to him were suitable for treatment with the Trellis device. In those patients with extensive thrombosis, pharmaco-mechanical thrombectomy is not suitable on its own, he said. But for every patient not suitable, O’Sullivan said he treated six who are; that is those with an iliofemoral thrombosis, and in some cases femoropopliteal, accessible via a mid-calf vein big enough to take an 8 French sheath.
O’Sullivan reported that at his institution they had performed more than 81 procedures with the device, and now had an average procedure time of one to one and a half hours.
"Contraindications which normally apply to catheter-directed thrombolysis do not apply in my opinion," O’Sullivan told delegates. "I’ve treated patients with haemorrhagic intracranial metastases, with active gastrointestinal bleeding. Because so little thrombosis is absorbed, there’s no drop in fibrinogen
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Viktor Knyazhev
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