Illustration of dissolving blood clot in leg vein.

Leg Saved: How a Dual Approach Conquered a Life-Threatening Blood Clot

Theo Raines in Health & Wellness December 2025 • 4 min read.

"Discover how a cutting-edge combination of catheter-directed thrombolysis (CDT) and factor Xa inhibitors is changing the game for inferior vena cava (IVC) thrombosis treatment."

Venous thromboembolism (VTE), encompassing deep venous thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk. While DVT is a common cardiovascular issue, a massive clot extending into the inferior vena cava (IVC) is a rarer, more perilous condition.

When faced with extensive thrombosis carrying a high risk of pulmonary embolism (PE), interventional treatment becomes crucial. The combination of catheter-directed thrombolysis (CDT) and factor Xa inhibitors represents a powerful approach to not only dissolve the clot but also prevent long-term complications.

This article explores a compelling case where the integration of CDT and a factor Xa inhibitor effectively resolved a life-threatening situation. The combination offers new hope for patients facing similar challenges. The case highlights the transformative impact of advanced medical interventions in treating complex vascular conditions.

The Case: A Race Against the Clock

Illustration of dissolving blood clot in leg vein.

A 70-year-old man sought medical help due to severe symptoms in his left leg, including warmth, pain, swelling, and difficulty walking. His medical history included bronchial asthma, steroid-induced diabetes mellitus, eosinophilic sinusitis, eosinophilic pneumonia, and cerebral infarction. Physical examination revealed significant swelling and tenderness in the affected leg, with the left thigh circumference notably larger than the right.

Initial diagnostic tests confirmed the worst: a pulmonary embolism (PE) and extensive DVT spreading into the IVC. The D-dimer level, a marker for blood clots, was alarmingly high. The patient's protein C level, an important natural anticoagulant, was notably low. Immediate intervention was necessary.

Initial Treatment with Fondaparinux: Subcutaneous fondaparinux, an anticoagulant, was administered. A Günther Tulip Filter was placed in the IVC to prevent the PE.
Catheter-Directed Thrombolysis (CDT): After a week, with limited improvement from fondaparinux alone, CDT was initiated. A Fountain infusion catheter was advanced into the thrombus, delivering urokinase directly to dissolve the clot.
Transition to Factor Xa Inhibitor: Following CDT, the treatment was switched to edoxaban, a direct oral anticoagulant (DOAC). This approach aimed to maintain the progress achieved by CDT and prevent recurrence.

The dual approach of CDT followed by edoxaban proved remarkably effective. The patient's symptoms improved significantly, and subsequent imaging showed a substantial reduction in the thrombus. He was discharged with a plan for continued oral anticoagulation. Follow-up examinations revealed minimal residual thrombi and normalized D-dimer levels, confirming the treatment's success.

A New Era in Thrombosis Treatment

The successful outcome in this case underscores the potential of combining CDT with factor Xa inhibitors for managing extensive DVT. This approach offers a targeted, effective way to dissolve clots and prevent complications, paving the way for improved outcomes and quality of life for patients facing these challenging conditions. The synergistic use of these therapies marks a significant advancement in the treatment of severe venous thromboembolism.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1097/md.0000000000011221, Alternate LINK

Title: Effect Of Combined Therapy With Catheter-Directed Thrombolysis And Factor Xa Inhibitor For Inferior Vena Cava Thrombosis

Subject: General Medicine

Journal: Medicine

Publisher: Ovid Technologies (Wolters Kluwer Health)

Authors: Daishi Nonaka, Hiroyuki Takase, Masashi Machii, Kazuto Ohno

Published: 2018-07-01

Everything You Need To Know

What is Catheter-Directed Thrombolysis (CDT), and how is it used in treating blood clots?

Catheter-Directed Thrombolysis (CDT) is a medical procedure used to dissolve blood clots directly. In this case, it was crucial for treating the 70-year-old man's extensive DVT and IVC thrombosis. A Fountain infusion catheter delivered urokinase directly to the thrombus in the inferior vena cava (IVC), which helped to break down the clot. This targeted approach is particularly useful when the clot is extensive and poses a high risk of pulmonary embolism (PE). The use of CDT allowed for direct treatment of the clot, which offered a more immediate and effective solution compared to systemic treatments alone.

How do factor Xa inhibitors, like edoxaban, contribute to the treatment of venous thromboembolism (VTE)?

Factor Xa inhibitors, such as edoxaban, play a crucial role in managing venous thromboembolism (VTE) by preventing the formation and extension of blood clots. In this case, after the patient underwent Catheter-Directed Thrombolysis (CDT), the treatment was switched to edoxaban. Edoxaban helped maintain the progress achieved by CDT by preventing the recurrence of the clot. It is a direct oral anticoagulant (DOAC), which means it works directly on factor Xa to inhibit the clotting cascade. This dual approach, combining CDT with a factor Xa inhibitor, proved effective in resolving the life-threatening situation and preventing future complications.

What were the specific symptoms and medical history of the 70-year-old man who was treated?

The 70-year-old man presented with severe symptoms in his left leg, including warmth, pain, swelling, and difficulty walking. His medical history was also quite extensive. It included bronchial asthma, steroid-induced diabetes mellitus, eosinophilic sinusitis, eosinophilic pneumonia, and cerebral infarction. These pre-existing conditions, along with the extensive DVT and pulmonary embolism (PE), created a complex and critical situation. The severity of his symptoms and the presence of a pulmonary embolism (PE) necessitated immediate and aggressive intervention.

Why was the combination of Catheter-Directed Thrombolysis (CDT) and factor Xa inhibitors considered a successful treatment approach?

The combination of Catheter-Directed Thrombolysis (CDT) and a factor Xa inhibitor was successful because it addressed the blood clot in two ways. CDT directly dissolved the existing thrombus, offering immediate relief and reducing the risk of pulmonary embolism (PE). Following CDT, the use of edoxaban, a factor Xa inhibitor, maintained the progress and prevented the clot from reforming. This dual approach was effective in dissolving the clot and preventing complications. The patient's symptoms improved significantly, and subsequent imaging showed a substantial reduction in the thrombus. Follow-up examinations confirmed the treatment's success with minimal residual thrombi and normalized D-dimer levels.

How does the use of a Günther Tulip Filter fit into the treatment plan for extensive deep venous thrombosis (DVT) and pulmonary embolism (PE)?

The Günther Tulip Filter was placed in the inferior vena cava (IVC) to prevent pulmonary embolism (PE). The filter's purpose was to catch any blood clots that might break away from the extensive DVT and travel to the lungs, which can cause a life-threatening PE. It served as a crucial temporary measure to protect the patient from a potentially fatal complication while other treatments, such as fondaparinux, Catheter-Directed Thrombolysis (CDT), and the factor Xa inhibitor, edoxaban, worked to dissolve the existing clots and prevent new ones from forming. This approach significantly reduced the immediate risk to the patient's life by addressing the potential for pulmonary embolism (PE).