Pharmacomechanical Thrombolysis

What is pharmacomechanical thrombolysis?

For patients with deep vein thrombosis, or DVT, pharmacomechanical thrombolysis is a method of destroying and removing clots located in deep veins, which combines clot-dissolving agents and mechanical devices to soften, break up and then remove the clot debris through suction. Unlike anticoagulant drugs, or blood thinners, which are used to prevent the formation of new clots in the majority of individuals with DVT, pharmacomechanical thrombolysis removes the existing clot, preventing possible vascular damage and reducing the risks that can occur when DVT clots break away from the vein where they are located.

How is the pharmacomechanical thrombolysis procedure performed?

The pharmacomechanical thrombolysis procedure is usually performed under sedation. Your specialist will insert a catheter, or thin, flexible tube, into the vein that contains the clot, passing the catheter carefully through the vein until the location of the clot is reached. The catheter surrounds the mechanical device used to break up the clot, and it is also used to deliver clot-dissolving agents. Once the catheter reaches the clot, it is advanced through the clot until the tip of the catheter emerges from the far side of the clot.

At this point, a tiny balloon is inflated at the catheter’s end. A second tiny balloon is inflated at the near end of the clot, effectively preventing the clot from breaking free during the maceration process. Once these tiny balloons are in place, the clot-dissolving agent is administered to the clot, and your specialist will activate the mechanical device that breaks the clot apart. Once the clot is completely broken apart, a tiny suction tip is used to remove the clot debris, the balloons are deflated and the catheter is removed. The entire procedure usually takes about 20 to 30 minutes.

What are the advantages of pharmacomechanical thrombolysis compared to traditional catheter-directed thrombolysis (CDT)?

Unlike CDT, which relies solely on the use of clot-dissolving drugs and requires ICU follow-up care or critical care monitoring following the procedure, these adjuncts are not required with pharmacomechanical thrombolysis. In addition, pharmacomechanical thrombolysis requires a much smaller dose of potentially dangerous clot-dissolving drugs than traditional CDT treatments. In clinical studies, pharmacomechanical thrombolysis has also been associated with less risk of bleeding complications than CDT.

What are the risks, side effects and recovery associated with pharmacomechanical thrombolysis?

Like other minimally invasive procedures, pharmacomechanical thrombolysis involves a very small risk of infection following the procedure. In addition, pharmacomechanical thrombolysis also has a small risk of bleeding complications and vascular injury.

Who is a candidate for pharmacomechanical thrombolysis?

Pharmacomechanical thrombolysis is a technique that is usually reserved for individuals suffering from deep vein thrombosis. Deep vein thrombosis is a condition in which clots form in the veins located deep within the body. Most DVT occurs in the veins of the legs, but these clots can occur elsewhere in the body. In some individuals, DVT may be asymptomatic, while others may experience pain, swelling or discoloration of the leg containing the clot, and in some individuals, the affected area will feel warmer to the touch than usual. In addition to localized discomfort, clots formed as a result of DVT can break away from the vein, traveling throughout the body where they can cause serious health risks. In some, the clot may travel to the lungs, causing a potentially fatal complication known as pulmonary embolism.

Reviewed February 7, 2017