Immunomodulation and Thrombolytic Approaches in the Management of Deep Vein Thrombosis and Pulmonary Embolism

Author(s): Angelie Pathak, Laura Roberts and Devendra K Agrawal

Deep vein thrombosis (DVT) and pulmonary embolism (PE) are key initiating events in the development of venous thromboembolism (VTE), a condition associated with significant morbidity, mortality, and long-term complications. While traditional therapies have focused on anticoagulation and thrombolysis, current evidence describes the pivotal role of immune pathways in the pathogenesis and progression of thrombosis. This review explores the multifaceted mechanisms underlying DVT and PE, emphasizing the contribution of inflammation, leukocyte activation, and immuno-thrombosis to thrombus formation and embolization. Key immune players such as neutrophil extracellular traps (NETs), inflammasomes, antibodies, and the STING pathway act in concert with coagulation cascades, highlighting potential targets for therapeutic modulation. We critically evaluated and discussed the efficacy and risks associated with thrombolytic agents such as alteplase, reteplase, and tenecteplase, particularly in severe or hemodynamically unstable cases. In addition, we reviewed new and innovative approaches including immune-targeted therapies and nanoparticle-based drug delivery systems, which provide the promise of more precise, safer, and cost-effective interventions. By integrating immunologic insights with evolving thrombolytic strategies, this paper supports a more tailored approach to managing DVT and PE, with the goal of reducing recurrence, minimizing complications, and enhancing long-term patient outcomes.