Powerful Clot-Busting Drugs Not Useful After Leg Blockages: Study

From Drugs.com - December 7, 2017

Powerful Clot-Busting Drugs Not Useful After Leg Blockages: Study

THURSDAY, Dec. 7, 2017 -- In a challenge to current medical practice, new research suggests the use of powerful clot-busting drugs in people with dangerous leg clots may not be routinely warranted.

Deep vein thrombosis (DVT) - the development of a clot in the lower legs - can prove deadly, since the clot can travel to the heart and lungs. DVTs are commonly referred to as "economy class syndrome," after cases were reported in passengers stuck on long-haul flights.

One common approach after a DVT is to use a catheter to deliver a powerful clot-busting drug -- such as tissue plasminogen activator (tPA) -- at the site of the clot. This was thought to help prevent a condition called post-thrombotic syndrome.

The complication can cause chronic limb pain and swelling, making it difficult for people who have had a DVT to walk or do daily activities, the researchers explained.

But using tPA and drugs like it for the condition come with the risk of excess bleeding. So, researchers led by Dr. Suresh Vedantham of Washington University in St Louis sought to determine if the approach really did help patients.

Their conclusion: In most cases, it did not.

The finding has a silver lining, Vendantham said.

"What we know now is that we can spare most patients the need to undergo a risky and costly treatment," he said in a university news release.

The study of nearly 700 U.S. patients with DVTs found that using catheters to clear the blockage with clot-busting drugs did not reduce the risk of post-thrombotic syndrome. The condition occurred in 47 percent of those who got the procedure, and 48 percent of those who did not, the study found.

There was a slight benefit in terms of reductions in the severity of post-thrombotic syndrome in people who got the clot-busters, however.

On the other hand, use of the drugs raised the risk of dangerous bleeding for patients, according to the study published Dec. 7 in the New England Journal of Medicine.

So, standard therapy -- the use of blood-thinning drugs -- may still be the most prudent course to take after a DVT, the research team concluded.

The study was funded by the U.S. National Heart, Lung, and Blood Institute (NHLBI).

"This landmark study, conducted at 56 clinical sites, demonstrated in an unbiased manner no benefits of catheter-directed thrombolysis [clot-removal] as a first-line DVT treatment, enabling patients to avoid an unnecessary medical procedure," said Dr. Andrei Kindzelski. He's the NHLBI program officer connected to the new trial.


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