Paget-Schroetter disease medical therapy: Difference between revisions

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==Overview==
==Overview==


* An effective treatment approach with lower rate of recurrent thrombus is a combination of Anti-coagulation, Thrombolytic agents and surgical decompression of the thoracic outlet.
* An effective treatment approach with lower rate of recurrent [[thrombus]] is a combination of [[Anticoagulant|Anti-coagulation]], [[Thrombolysis|Thrombolytic]] agents and surgical [[decompression]] of the [[Superior thoracic aperture|thoracic outlet]].
* Catheter-directed thrombolysis injection has proven to be effective as systemic thrombolytic agents without any worrisome systemic side effects.
*[[Catheter]]-directed [[thrombolysis]] injection has proven to be effective as systemic thrombolytic agents without any worrisome systemic side effects.


==Medical Therapy==
==Medical Therapy==


* Considering more belligerent treatment method cite greater outcomes with lower rate of recurrent [[thrombus]]. Belligerent treatment method compromises of [[Anticoagulant|anticoagulation]], [[thrombolysis|thrombolytic agents]], and surgical [[decompression]] of the [[thoracic outlet]] with repair of the affected venous system.<ref name="RinghouseJackson20173">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
* Considering more belligerent treatment method cite greater outcomes with lower rate of recurrent [[thrombus]]. Belligerent treatment method compromises of [[Anticoagulant|anticoagulation]], [[thrombolysis|thrombolytic agents]], and surgical [[decompression]] of the [[thoracic outlet]] with repair of the affected venous system.<ref name="RinghouseJackson20173">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
*[[Monotherapy]] with [[Anticoagulant|anticoagulants]] is reported inefficient, since approximately 80% of cases ended up with residual [[Vein|venous]] [[obstruction]] and 90% experienced persistence symptoms.<ref name="Rosa SalazarOtálora Valderrama2015">{{cite journal|last1=Rosa Salazar|first1=Vladimir|last2=Otálora Valderrama|first2=Sonia del Pilar|last3=Hernández Contreras|first3=María Encarnación|last4=García Pérez|first4=Bartolomé|last5=Arroyo Tristán|first5=Andrés del Amor|last6=García Méndez|first6=María del Mar|title=Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients|journal=Archivos de Bronconeumología (English Edition)|volume=51|issue=8|year=2015|pages=e41–e43|issn=15792129|doi=10.1016/j.arbr.2015.05.026}}</ref>
* Systemic [[fibrinolysis]]:
* Systemic [[fibrinolysis]]:
** More efficient than [[Anticoagulant|anticoagulation]] therapy<ref name="pmid21079709">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
** More efficient than [[Anticoagulant|anticoagulation]] therapy<ref name="pmid21079709">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
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* Local [[catheter]]-directed [[thrombolysis]]:  
* Local [[catheter]]-directed [[thrombolysis]]:  
** Recommended in all early presenting patients based on some studies<ref name="pmid210797095">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>, while others suggest this method for sever cases, large [[thrombus]], low risk of [[bleeding]], patients with good general health condition and [[life expectancy]] more than a year.<ref name="RinghouseJackson20172">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
** Recommended in all early presenting patients based on some studies<ref name="pmid210797095">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>, while others suggest this method for sever cases, large [[thrombus]], low risk of [[bleeding]], patients with good general health condition and [[life expectancy]] more than a year.<ref name="RinghouseJackson20172">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
** Studies have been demonstrated that there is an indirect relationship between efficacy of local [[Thrombolytic drug|thrombolytic therapy]] and duration between symptom onset to treatment. Therefore it is critical to diagnose and treat as soon as possible.<ref name="pmid210797097">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>  
** Studies have been demonstrated that there is an indirect relationship between efficacy of local [[Thrombolytic drug|thrombolytic therapy]] and duration between symptom onset to treatment. Therefore it is critical to diagnose and treat as soon as possible.<ref name="pmid210797097">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
**Some studies suggest to consider local [[catheter]]-directed [[thrombolysis]] within the first 14 days of symptoms onset with success rate of 84%<ref name="RinghouseJackson2017">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
**Some studies suggest to consider local [[catheter]]-directed [[thrombolysis]] within the first 14 days of symptoms onset with success rate of 84%<ref name="RinghouseJackson2017">{{cite journal|last1=Ringhouse|first1=Brendan|last2=Jackson|first2=Cody|title=Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study|journal=Military Medicine|volume=182|issue=5|year=2017|pages=e1826–e1829|issn=0026-4075|doi=10.7205/MILMED-D-16-00359}}</ref>
**In a study done by Baylor, none of the cases who underwent [[catheter]]-directed [[thrombolysis]] more than 6 weeks after symptom onset had a complete vein recanalization. Moreover only 50% of these cases result in partial vein patency.<ref name="IlligDoyle2010">{{cite journal|last1=Illig|first1=Karl A.|last2=Doyle|first2=Adam J.|title=A comprehensive review of Paget-Schroetter syndrome|journal=Journal of Vascular Surgery|volume=51|issue=6|year=2010|pages=1538–1547|issn=07415214|doi=10.1016/j.jvs.2009.12.022}}</ref>
**In a study done by Baylor, none of the cases who underwent [[catheter]]-directed [[thrombolysis]] more than 6 weeks after symptom onset had a complete vein recanalization. Moreover only 50% of these cases result in partial vein patency.<ref name="IlligDoyle2010">{{cite journal|last1=Illig|first1=Karl A.|last2=Doyle|first2=Adam J.|title=A comprehensive review of Paget-Schroetter syndrome|journal=Journal of Vascular Surgery|volume=51|issue=6|year=2010|pages=1538–1547|issn=07415214|doi=10.1016/j.jvs.2009.12.022}}</ref>
**Based on two studies, success rates of [[catheter]]-directed [[thrombolysis]] have been reported only 22% and 25% in a large [[thrombus]] with greater [[Thrombus|clot]] burden.<ref name="IlligDoyle20102">{{cite journal|last1=Illig|first1=Karl A.|last2=Doyle|first2=Adam J.|title=A comprehensive review of Paget-Schroetter syndrome|journal=Journal of Vascular Surgery|volume=51|issue=6|year=2010|pages=1538–1547|issn=07415214|doi=10.1016/j.jvs.2009.12.022}}</ref>  
**Based on two studies, success rates of [[catheter]]-directed [[thrombolysis]] have been reported only 22% and 25% in a large [[thrombus]] with greater [[Thrombus|clot]] burden.<ref name="IlligDoyle20102">{{cite journal|last1=Illig|first1=Karl A.|last2=Doyle|first2=Adam J.|title=A comprehensive review of Paget-Schroetter syndrome|journal=Journal of Vascular Surgery|volume=51|issue=6|year=2010|pages=1538–1547|issn=07415214|doi=10.1016/j.jvs.2009.12.022}}</ref>
** Same efficacy as systemic [[Thrombolytic drug|thrombolytic agents]] without any systemic [[Adverse effect (medicine)|side effects]]<ref name="pmid210797096">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
** Same efficacy as systemic [[Thrombolytic drug|thrombolytic agents]] without any systemic [[Adverse effect (medicine)|side effects]]<ref name="pmid210797096">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
** Newer agents like [[Alteplase (injection)|Alteplase]] and [[Reteplase]] are safer compared to [[urokinase]] or [[streptokinase]] <ref name="pmid210797093">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>
** Newer agents like [[Alteplase (injection)|Alteplase]] and [[Reteplase]] are safer compared to [[urokinase]] or [[streptokinase]] <ref name="pmid210797093">{{cite journal| author=Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK| title=Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. | journal=West J Emerg Med | year= 2010 | volume= 11 | issue= 4 | pages= 358-62 | pmid=21079709 | doi= | pmc=2967689 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21079709  }}</ref>

Revision as of 21:03, 15 June 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Medical Therapy

  • Local catheter-directed thrombolysis:
    • Recommended in all early presenting patients based on some studies[5], while others suggest this method for sever cases, large thrombus, low risk of bleeding, patients with good general health condition and life expectancy more than a year.[6]
    • Studies have been demonstrated that there is an indirect relationship between efficacy of local thrombolytic therapy and duration between symptom onset to treatment. Therefore it is critical to diagnose and treat as soon as possible.[7]
    • Some studies suggest to consider local catheter-directed thrombolysis within the first 14 days of symptoms onset with success rate of 84%[8]
    • In a study done by Baylor, none of the cases who underwent catheter-directed thrombolysis more than 6 weeks after symptom onset had a complete vein recanalization. Moreover only 50% of these cases result in partial vein patency.[9]
    • Based on two studies, success rates of catheter-directed thrombolysis have been reported only 22% and 25% in a large thrombus with greater clot burden.[10]
    • Same efficacy as systemic thrombolytic agents without any systemic side effects[11]
    • Newer agents like Alteplase and Reteplase are safer compared to urokinase or streptokinase [12]
    • The average duration of thrombolytic infusion via catheter is estimated between 24-48 hours[13]
    • Lee et al. suggested that patients younger than 28 who received thrombolysis had a higher chance of recurrent thrombus. Although more studies is required.[14]

References

  1. ↑ Ringhouse, Brendan; Jackson, Cody (2017). "Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study". Military Medicine. 182 (5): e1826–e1829. doi:10.7205/MILMED-D-16-00359. ISSN 0026-4075.
  2. ↑ Rosa Salazar, Vladimir; Otálora Valderrama, Sonia del Pilar; Hernández Contreras, María Encarnación; García Pérez, Bartolomé; Arroyo Tristán, Andrés del Amor; García Méndez, María del Mar (2015). "Multidisciplinary Management of Paget-Schroetter Syndrome. A Case Series of Eight Patients". Archivos de Bronconeumología (English Edition). 51 (8): e41–e43. doi:10.1016/j.arbr.2015.05.026. ISSN 1579-2129.
  3. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  4. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  5. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  6. ↑ Ringhouse, Brendan; Jackson, Cody (2017). "Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study". Military Medicine. 182 (5): e1826–e1829. doi:10.7205/MILMED-D-16-00359. ISSN 0026-4075.
  7. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  8. ↑ Ringhouse, Brendan; Jackson, Cody (2017). "Bringing to Light Symptoms and Treatments of Effort Thrombosis (Paget–Schroetter Syndrome) in the Military Population, a Case Study". Military Medicine. 182 (5): e1826–e1829. doi:10.7205/MILMED-D-16-00359. ISSN 0026-4075.
  9. ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.
  10. ↑ Illig, Karl A.; Doyle, Adam J. (2010). "A comprehensive review of Paget-Schroetter syndrome". Journal of Vascular Surgery. 51 (6): 1538–1547. doi:10.1016/j.jvs.2009.12.022. ISSN 0741-5214.
  11. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  12. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  13. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.
  14. ↑ Alla VM, Natarajan N, Kaushik M, Warrier R, Nair CK (2010). "Paget-schroetter syndrome: review of pathogenesis and treatment of effort thrombosis". West J Emerg Med. 11 (4): 358–62. PMC 2967689. PMID 21079709.

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