Current state of treatment for lower extremity acute deep venous thrombosis (a literature review)

Abstract

Despite the use of modern methods of diagnosis and treatment, deep vein thrombosis (DVT) of the lower extremities remains a fairly common disease. In half of all cases, DVT may be asymptomatic and manifest itself in subsequent symptoms of pulmonary embolism (PE) or postthrombotic syndrome (PTS). An important role in the pathogenesis of this disease is played by a variety of factors and conditions that contribute to thrombosis in the venous vessels of the lower extremities, as well as impaired venous outflow from the lower extremity due to blockage of the venous lumen by such a thrombus. The action of various treatments is aimed at certain links in the pathogenesis, namely: anticoagulant therapy prevents further thrombosis, thrombolysis dissolves blood clots, surgical and mechanical thrombectomy remove blood clots from the lumen of the vein, lysis or removal of thrombotic masses restores thrombosis in the small circle of blood circulation. There is no single, universal method for combating DVT. In addition, there are new methods, such as the use of devices for pharmaco-mechanical thrombolysis, stent-retrievers which need to be tested for effectiveness and safety, as well as for a comparative analysis with existing treatments. Given the severe consequences of DVT that include early mortality, recurrence and complications of the disease, and can be associated with death, rehospitalization, deterioration in patient quality of life and disability, the choice and application of certain treatments or combinations thereof becomes important. Equally important are the issues of primary and secondary prevention of DVT, which reduce the above-mentioned risks and should be pursued in each patient. The aim. To study the world experience in the treatment of DVT, to summarize modern approaches to the treatment of patients with DVT based on the principles of evidence-based medicine by reviewing and analyzing modern scientific literary sources in scientometric bases. Materials and methods. We searched for publications in scientometric databases including Pub Med, Google Scholar, Web of Sciense, Scopus by keywords, as well as for the latest recommendations and guidelines that cover modern methods of diagnosis and treatment of DVT of the lower extremities. Articles, systematic reviews and literature relevant to the research topic were reviewed and analyzed. The inclusion criteria were: articles and studies describing to the pathophysiology, diagnosis and treatment of DVT, studies with the longest observation, recommendations and guidelines of professional associations regarding DVT. The exclusion criteria were: articles not related to the research topic, a small number of patients included in the study (less than 15 people). Conclusions. DVT and its complications can lead to fatal conditions, such as pulmonary embolism, and often adversely affect patients’ quality of life. DVT is potentially life-threatening and should be considered by a physician and patient as a life-threatening disease. Anticoagulant therapy is the main option for both DVT treatment and secondary prevention of venous thromboembolism and PTS recurrence. Some patients may receive drug therapy on an outpatient basis. Other patients with severe disease and complications need inpatient management. An open surgery, percutaneous endovascular procedures and various combinations thereof with the addition of anticoagulant therapy could be applied to this group. The lack of clear criteria for selecting patients and indications for endovascular interventions and surgical thrombectomy requires further research in this area.

Keywords

• deep vein thrombosis
• anticoagulant therapy
• thrombolysis
• thrombectomy
• prevention of venous thromboembolism