Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum

Mark H. Meissner, Peter Gloviczki, Anthony J. Comerota, Michael C. Dalsing, Bo G. Eklof, David L. Gillespie, Joann M. Lohr, Robert Mclafferty, M. Hassan Murad, Frank Padberg, Peter Pappas, Joseph D. Raffetto, Thomas W. Wakefield

Research output: Contribution to journalArticle

206 Citations (Scopus)

Abstract

Background: The anticoagulant treatment of acute deep venous thrombosis (DVT) has been historically directed toward the prevention of recurrent venous thromboembolism. However, such treatment imperfectly protects against late manifestations of the postthrombotic syndrome. By restoring venous patency and preserving valvular function, early thrombus removal strategies can potentially decrease postthrombotic morbidity. Objective: A committee of experts in venous disease was charged by the Society for Vascular Surgery and the American Venous Forum to develop evidence-based practice guidelines for early thrombus removal strategies, including catheter-directed pharmacologic thrombolysis, pharmacomechanical thrombolysis, and surgical thrombectomy. Methods: Evidence-based recommendations are based on a systematic review and meta-analysis of the relevant literature, supplemented when necessary by less rigorous data. Recommendations are made according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, incorporating the strength of the recommendation (strong: 1; weak: 2) and an evaluation of the level of the evidence (A to C). Results: On the basis of the best evidence currently available, we recommend against routine use of the term "proximal venous thrombosis" in favor of more precise characterization of thrombi as involving the iliofemoral or femoropopliteal venous segments (Grade 1A). We further suggest the use of early thrombus removal strategies in ambulatory patients with good functional capacity and a first episode of iliofemoral DVT of

Original languageEnglish (US)
Pages (from-to)1449-1462
Number of pages14
JournalJournal of Vascular Surgery
Volume55
Issue number5
DOIs
StatePublished - May 2012
Externally publishedYes

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Practice Guidelines
Venous Thrombosis
Thrombosis
Postthrombotic Syndrome
Thrombectomy
Evidence-Based Practice
Venous Thromboembolism
Anticoagulants
Meta-Analysis
Catheters
Morbidity
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

Early thrombus removal strategies for acute deep venous thrombosis : Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. / Meissner, Mark H.; Gloviczki, Peter; Comerota, Anthony J.; Dalsing, Michael C.; Eklof, Bo G.; Gillespie, David L.; Lohr, Joann M.; Mclafferty, Robert; Murad, M. Hassan; Padberg, Frank; Pappas, Peter; Raffetto, Joseph D.; Wakefield, Thomas W.

In: Journal of Vascular Surgery, Vol. 55, No. 5, 05.2012, p. 1449-1462.

Research output: Contribution to journalArticle

Meissner, MH, Gloviczki, P, Comerota, AJ, Dalsing, MC, Eklof, BG, Gillespie, DL, Lohr, JM, Mclafferty, R, Murad, MH, Padberg, F, Pappas, P, Raffetto, JD & Wakefield, TW 2012, 'Early thrombus removal strategies for acute deep venous thrombosis: Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum', Journal of Vascular Surgery, vol. 55, no. 5, pp. 1449-1462. https://doi.org/10.1016/j.jvs.2011.12.081
Meissner, Mark H. ; Gloviczki, Peter ; Comerota, Anthony J. ; Dalsing, Michael C. ; Eklof, Bo G. ; Gillespie, David L. ; Lohr, Joann M. ; Mclafferty, Robert ; Murad, M. Hassan ; Padberg, Frank ; Pappas, Peter ; Raffetto, Joseph D. ; Wakefield, Thomas W. / Early thrombus removal strategies for acute deep venous thrombosis : Clinical Practice Guidelines of the Society for Vascular Surgery and the American Venous Forum. In: Journal of Vascular Surgery. 2012 ; Vol. 55, No. 5. pp. 1449-1462.
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