Anticoagulation with heparin alone is usually insufficient in lysing the thrombi and preserving valve function in patients with deep venous thrombosis. Despite wide acceptance of effectiveness of thrombolytic therapy in patients with deep venous thrombosis, it is seldom used for this indication in our country. This study was designed to compare the effectiveness of systemic thrombolytic therapy, which is much easier to perform compared to direct methods with anticoagulation using heparin. Another aim of the study was also to determine the subgroup of patients with the highest rate of thrombolysis using thrombolytic therapy.

Between March 1996-June 1999 69 patients with a definite diagnosis of deep venous thrombosis by duplex study was enroled into the study. Forty-nine-patients received systemic thrombolytic therapy and 20 patients were anticoagulated with heparin. All 69 patients underwent control venous duplex study to determine thrombolysis.

Venous flow was achieved in only 1 patient (5%) receiving heparin compared to 28 patients (57%) receiving thrombolytic therapy (p=0.000). Hemorhagic complications were encountered in two patients ad these patients responded well to conservative measures. When patients in the thrombolytic therapy group were analysed patients who underwent treatment 4 days after the initial onset had a higher response rate (87%) compared to patients who were treated 5 days of after (31%, p=0.000).

In conclusion we have found systemic thrombolytic therapy to be more succesful in achieving thrombolysis compared to heparin alone. We believe systemic thrombolytic therapy is effective and safe for treating deep venous thrombosis particularly in patients who present early.

Keywords :