Suitability for catheter-directed thrombolysis in patients with acute lower extremity deep vein thrombosis according to various international consensus guidelines

Stefanescu, Adrian; Alatri, Adriano; Périard, Daniel; Kucher, Nils; Mazzolai, Lucia; Engelberger, Rolf P.

doi:10.1016/j.thromres.2018.01.029

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“…[14][15][16] Based on the results of small randomized-controlled trials and prospective cohort studies, clinical practice guidelines suggest the use of early thrombus removal strategies and adjunctive use of venous stents for residual obstructive vein lesions as first-line therapy in selected patients with acute IFDVT and low bleeding risk. [17][18][19][20] Anticoagulation therapy remains the cornerstone for patients with DVT. Recently, direct oral anticoagulants (DOAC), including rivaroxaban, have replaced vitamin K-antagonists (VKA) as first-line therapy in most DVT patients, due to reduced risk of major bleeding [21][22][23][24] and increased patient comfort.…”

Section: Introductionmentioning

confidence: 99%

Rivaroxaban or vitamin-K antagonists following early endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis

Sebastian

Hakki

Spirk

et al. 2018

Thrombosis Research

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Background The optimal anticoagulant following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) is unknown. Methods From the Swiss Venous Stent registry, an ongoing prospective cohort study, we performed a subgroup analysis of patients with acute IFDVT who underwent catheter-based early thrombus removal followed by nitinol stent placement. Duplex ultrasound and Villalta scores were used to determine patency rates and incidence of the post-thrombotic syndrome (PTS) in patients treated with either rivaroxaban (n = 73) or a vitamin K-antagonist (VKA; n = 38) for a minimum duration of 3 months. Results Mean follow-up duration was 24 ± 19 months (range 3 to 77 months). Anticoagulation therapy was time-limited (3 to 12 months) in 56% of patients (47% in the rivaroxaban group and 58% in the VKA group, p = 0.26), with shorter mean duration of anticoagulation in the rivaroxaban group (180 ± 98 days versus 284 ± 199 days, p = 0.01). Overall, primary and secondary patency rates at 24 months were 82% (95%CI, 71-89%) and 95% (95%CI, 87-98%), respectively, with no difference between the rivaroxaban (87% [95%CI, 76-94%] and 95% [95%CI, 85-98%]) and the VKA group (72% [95%CI, 52-86%] and 94% [95%CI, 78-99%]; p > 0.10 for both). Overall, 86 (86%) patients were free from PTS at latest follow-up, with no difference between the rivaroxaban and the VKA groups (57 [85%] versus 29 [88%]; p = 0.76). Two major bleeding complications (1 in each group) occurred in the peri-interventional period, without any major bleeding thereafter. Conclusions In patients with acute IFDVT treated with catheter-based early thrombus removal and venous stent placement, the effectiveness and safety of rivaroxaban and VKA appear to be similar.

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