Illustration of a blocked artery transforming into a flowing river, symbolizing the successful treatment of deep vein thrombosis.

Unblocking the Body: How Combined Therapy Tackles Deep Vein Thrombosis

Reese Marlowe in Health & Wellness July 2025 • 4 min read.

"Discover how a pioneering approach using catheter-directed thrombolysis (CDT) and factor Xa inhibitors is revolutionizing the treatment of extensive deep vein thrombosis (DVT) and improving patient outcomes."

Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), poses a significant health risk due to potential complications like recurrent VTE, postthrombotic syndrome (PTS), and even sudden death. While DVT ranks as the third most prevalent cardiovascular condition after heart attacks and strokes, a massive DVT that extends to the inferior vena cava (IVC) is a less common but serious occurrence.

When a patient experiences extensive thrombosis, particularly with a high risk of pulmonary embolism (PE), interventional treatment becomes crucial. Current medical evidence suggests that catheter-directed thrombolysis (CDT) can significantly reduce clot burden, prevent DVT recurrence, and lower the risk of developing postthrombotic syndrome (PTS) compared to standard anticoagulation methods. This approach offers a targeted way to break down clots and restore proper blood flow.

This article delves into a compelling case of a patient suffering from both PE and extensive DVT that spread into the IVC. We'll examine how a combined treatment strategy involving CDT and a factor Xa inhibitor successfully addressed this complex condition, offering valuable insights into innovative approaches for managing severe thrombosis.

The Power of Combined Therapy: How CDT and Factor Xa Inhibitors Work Together

Illustration of a blocked artery transforming into a flowing river, symbolizing the successful treatment of deep vein thrombosis.

A 70-year-old man, with a history of bronchial asthma and steroid-induced diabetes, was admitted to the hospital with complaints of warmth, pain, and swelling in his left leg, along with gait disturbance. Diagnostic tests, including contrast-enhanced computed tomography (CT) and venous ultrasonography, confirmed the presence of a pulmonary embolism (PE) and extensive DVT that extended into the inferior vena cava (IVC).

Initial treatment with fondaparinux proved insufficient. Consequently, doctors turned to catheter-directed thrombolysis (CDT) using a Fountain infusion catheter to directly target and break down the clots. After CDT, the patient was transitioned to a direct oral anticoagulant (DOAC), specifically a factor Xa inhibitor, to prevent further clot formation.

Fondaparinux: An initial anticoagulant medication that did not provide sufficient clot resolution in this case.
Catheter-Directed Thrombolysis (CDT): A minimally invasive procedure using a Fountain infusion catheter to deliver clot-dissolving medication directly to the thrombus.
Fountain Infusion Catheter: A specialized catheter with multiple side holes to disperse urokinase, a thrombolytic agent, directly into the thrombus.
Urokinase: A thrombolytic agent used in CDT to break down the blood clots.
Factor Xa Inhibitor (Edoxaban): A direct oral anticoagulant (DOAC) used to prevent further clot formation after CDT.

The combined approach of CDT followed by a factor Xa inhibitor yielded remarkable results. The patient experienced significant improvement in his DVT, with a reduction in swelling and pain in his left leg. Subsequent imaging confirmed a decrease in the size and extent of the thrombi. Importantly, the patient's symptoms resolved, and there was no recurrence of thrombosis during the follow-up period.

A New Era in DVT Treatment

This case highlights the potential of combining CDT with factor Xa inhibitors to effectively manage extensive DVT and prevent long-term complications. While further research is needed to optimize treatment protocols and identify ideal candidates, this approach offers a promising avenue for improving outcomes in patients with severe venous thromboembolism. The successful outcome underscores the importance of considering interventional strategies, like CDT, in conjunction with anticoagulant therapy for comprehensive DVT management.

About this Article -

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Everything You Need To Know

What is the primary goal of using Catheter-Directed Thrombolysis (CDT) in treating Deep Vein Thrombosis (DVT)?

The primary goal of using Catheter-Directed Thrombolysis (CDT) in treating Deep Vein Thrombosis (DVT) is to directly target and break down the blood clots (thrombi) within the veins. This approach aims to restore proper blood flow, reduce clot burden, prevent DVT recurrence, and lower the risk of developing postthrombotic syndrome (PTS). CDT achieves this by delivering clot-dissolving medication, like urokinase, directly to the affected area using a Fountain infusion catheter, offering a targeted method compared to standard anticoagulation methods alone.

How do Factor Xa inhibitors contribute to the treatment of Deep Vein Thrombosis (DVT) when used in conjunction with Catheter-Directed Thrombolysis (CDT)?

Factor Xa inhibitors, such as Edoxaban, play a crucial role in DVT treatment alongside Catheter-Directed Thrombolysis (CDT) by preventing further clot formation. After CDT breaks down the existing clots, Factor Xa inhibitors act as a direct oral anticoagulant (DOAC) to inhibit the factor Xa protein, which is essential for the blood clotting cascade. This combined approach addresses both the immediate need to dissolve clots and the ongoing need to prevent new clots from forming, significantly reducing the risk of recurrence and long-term complications associated with DVT, such as postthrombotic syndrome (PTS).

What are the potential long-term complications of Deep Vein Thrombosis (DVT) and how does the combined therapy of Catheter-Directed Thrombolysis (CDT) and Factor Xa inhibitors aim to mitigate these?

The long-term complications of Deep Vein Thrombosis (DVT) include recurrent venous thromboembolism (VTE), postthrombotic syndrome (PTS), and even sudden death. Recurrent VTE involves the re-formation of blood clots, potentially leading to further blockages and complications. Postthrombotic syndrome (PTS) can cause chronic leg pain, swelling, skin changes, and ulcers due to long-term damage to the veins. The combined therapy of Catheter-Directed Thrombolysis (CDT) and Factor Xa inhibitors aims to mitigate these complications by first directly breaking down the existing clots with CDT. Subsequently, Factor Xa inhibitors prevent new clots, reducing the chances of recurrence. This comprehensive approach improves blood flow and minimizes the risk of developing PTS, significantly improving patient outcomes and quality of life.

In the case study, why was Fondaparinux deemed insufficient, and what were the subsequent steps taken to treat the patient's extensive DVT?

In the case study, Fondaparinux, an initial anticoagulant, proved insufficient because it did not provide sufficient clot resolution in the patient with extensive DVT. Consequently, the doctors determined that a more aggressive intervention was necessary. The subsequent steps involved Catheter-Directed Thrombolysis (CDT) using a Fountain infusion catheter to directly target and break down the clots with a thrombolytic agent. Following CDT, the patient was transitioned to a Factor Xa inhibitor (Edoxaban), a direct oral anticoagulant (DOAC), to prevent further clot formation and reduce the risk of recurrence. This combined approach, which addressed both immediate clot breakdown and long-term prevention, yielded remarkable results, indicating the effectiveness of the treatment strategy.

What is the role of the Fountain infusion catheter and urokinase in the treatment of Deep Vein Thrombosis (DVT) using Catheter-Directed Thrombolysis (CDT)?

In the treatment of Deep Vein Thrombosis (DVT) using Catheter-Directed Thrombolysis (CDT), the Fountain infusion catheter serves as the delivery mechanism for the thrombolytic agent, urokinase. The Fountain infusion catheter is a specialized catheter with multiple side holes, which allows the medical team to disperse urokinase directly into the thrombus (blood clot). Urokinase, a thrombolytic agent, works by breaking down the blood clots, thereby restoring proper blood flow and reducing the risk of complications. The use of the Fountain infusion catheter allows for a targeted and minimally invasive approach to dissolving the clots, maximizing the effectiveness of the treatment while minimizing potential side effects.