Clinical effects and safety of anticoagulation and endovascular therapy for acute deep venous thrombosis

doi:10.3877/cma.j.issn.1674-0785.2019.10.001

Abstract

Abstract:

Objective

To investigate the clinical effects and safety of anticoagulation and endovascular therapy for acute iliac-femoral venous thrombosis (I-FVT).

Methods

A total of 142 patients who were definitely diagnosed with acute I-FVT were included from January 2015 to September 2016 in Xinjiang Uygur Autonomous Region People′s Hospital, including 40 cases undergoing anticoagulant therapy, (anticoagulation group) and 102 cases undergoing percutaneous endovascular therapy [endovascular therapy group; catheter directed thrombolysis (CDT), percutaneous mechanical thrombus removal (PMT), and PMT combined with CDT]. The cure rate, effective rate, and the degree of thrombus removal were compared between the two groups. The incidence of adverse events during treatment and the follow-up period was recorded.

Results

The cure rate (above knee: 58.8% vs 12.5%; below knee: 53.9% vs 10.0%), effective rate (above knee: 96.1% vs 65.0%; below knee: 97.1% vs 75.0%), and degree of thrombus removal differed significantly between the endovascular therapy group and anticoagulation group (P<0.001). During the 3-month follow-up period, there were 7 cases of puncture site hematoma, 13 cases of hematuria, 2 cases of secondary thrombosis of contralateral limbs, and 1 case of contrast-related nephropathy in endovascular therapy group. During the 6-, 12-, 24-month follow-up periods, the recurrence rate of deep venous thrombosis (7.8% vs 22.5%, 12.7% vs 27.5%, 18.4% vs 37.8%), the incidence of post-thrombotic syndrome (15.7% vs 37.5%, 20.6% vs 42.5%, 25.5% vs 54.1%), and Villalta score [(2.24±2.13) vs (5.15±2.93), (3.32±2.88) vs (6.90±4.07), (4.22±3.93) vs (8.11±4.85)] were significantly lower in the endovascular therapy group than in the anticoagulant therapy group (P<0.05).

Conclusion

Endovascular therapy for acute I-FVT has better efficacy than anticoagulation treatment alone, but endovascular therapy is invasive with more adverse events.

Key words: Venous thrombosis, Anticoagulation therapy, Endovascular therapy

Jianping Yang, Hongbo Ci, Qingbo Fang, Sheng Guan, Xiaohu Ge. Clinical effects and safety of anticoagulation and endovascular therapy for acute deep venous thrombosis[J]. Chinese Journal of Clinicians(Electronic Edition), 2019, 13(10): 721-725.

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References 18

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组别	例数	年龄（岁）	性别（例）		患肢（例）		病程（d，±s）	血栓分布评分（分，±s）	健侧与患侧周径差（cm，±s）
组别	例数	年龄（岁）	男	女	左	右	病程（d，±s）	血栓分布评分（分，±s）	膝上	膝下
抗凝组	40	56.10±18.17	15	25	32	8	6.08±4.02	6.78±1.25	5.60±2.15	3.86±1.56
腔内组	102	57.89±15.69	41	61	83	19	6.08±3.62	7.07±1.30	6.07±2.28	3.78±1.49
统计值	?	t=-0.585	χ²=0.087		χ²=0.035		t=-0.005	t=-1.224	t=-1.126	t=0.288
P值	?	0.559	0.767		0.851		0.996	0.223	0.262	0.774

组别	例数	年龄（岁）	性别（例）		患肢（例）		病程（d，±s）	血栓分布评分（分，±s）	健侧与患侧周径差（cm，±s）
组别	例数	年龄（岁）	男	女	左	右	病程（d，±s）	血栓分布评分（分，±s）	膝上	膝下
抗凝组	40	56.10±18.17	15	25	32	8	6.08±4.02	6.78±1.25	5.60±2.15	3.86±1.56
腔内组	102	57.89±15.69	41	61	83	19	6.08±3.62	7.07±1.30	6.07±2.28	3.78±1.49
统计值	?	t=-0.585	χ²=0.087		χ²=0.035		t=-0.005	t=-1.224	t=-1.126	t=0.288
P值	?	0.559	0.767		0.851		0.996	0.223	0.262	0.774

组别	例数	膝上				膝下
组别	例数	优	良	中	差	优	良	中	差
抗凝组	40	5（12.5）	7（17.5）	14（35.0）	14（35.0）	4（10.0）	14（35.0）	12（30.0）	10（25.0）
腔内组	102	60（58.8）	28（27.5）	10（9.8）	4（3.9）	55（53.9）	31（30.4）	13（12.7）	3（2.9）
Z值	?	-4.622				-5.633
P值	?	<0.001				<0.001

组别	例数	膝上				膝下
组别	例数	优	良	中	差	优	良	中	差
抗凝组	40	5（12.5）	7（17.5）	14（35.0）	14（35.0）	4（10.0）	14（35.0）	12（30.0）	10（25.0）
腔内组	102	60（58.8）	28（27.5）	10（9.8）	4（3.9）	55（53.9）	31（30.4）	13（12.7）	3（2.9）
Z值	?	-4.622				-5.633
P值	?	<0.001				<0.001

组别	例数	膝上		膝下
组别	例数	治愈率	有效率	治愈率	有效率
抗凝组	40	5（12.5）	26（65.0）	4（10.0）	30（75.0）
腔内组	102	60（58.8）	98（96.1）	55（53.9）	99（97.1）
χ²值	?	24.840	25.071	22.823	16.810
P值	?	<0.001	<0.001	<0.001	<0.001

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