Association of localized circumferential elastic compression with short-term recanalization and safety during urokinase thrombolysis for lower extremity deep vein thrombosis

Systemic urokinase infusion via the dorsal foot vein is commonly used for acute lower-extremity deep-vein thrombosis (DVT) complicated by pulmonary embolism (PE), but drug dilution within the superficial venous system may reduce local efficacy. We evaluated whether localized circumferential elastic compression applied at the thigh level was associated with improved short-term recanalization without compromising safety during urokinase thrombolysis. In this retrospective cross-sectional study, 207 consecutive patients with acute proximal DVT and concomitant PE received urokinase via the dorsal foot vein and were stratified by use of localized circumferential elastic compression. The primary outcome was ≥ 50% venous recanalization on duplex ultrasound at 4 weeks. Compression was applied in 93 patients (44.9%). Recanalization was higher with compression than without (62.4% vs. 47.4%; adjusted OR 3.60, 95% CI 1.73-7.47; P = 0.001), without an increase in bleeding or limb complications (5.4% vs. 11.4%; P = 0.126). Benefits were consistent across key subgroups. These findings suggest an association between localized compression and improved short-term recanalization.