Research Article
BibTex RIS Cite

The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study

Year 2021, Volume: 13 Issue: 2, 312 - 318, 07.06.2021
https://doi.org/10.18521/ktd.807493

Abstract

Objective: This clinical study included a retrospective evaluation of 138 patients using new oral anticoagulants (rivaroxaban, dabigatran, apixaban, edoxaban) for lower extremity deep vein thrombosis. The demographic characteristics of the patients and the relationship between the disease, treatment initiation and end times, radiological and clinical recovery, and NOACSSS side effects were evaluated.

Materials and Method: 138 patients using new oral anticoagulant drugs were included in the retrospective study. Demographic characteristics, diagnosis and treatment charts, radiological images, epicrisis notes of the patients were recorded. Records of each patient were reviewed during their 12 months of follow-up. New oral anticoagulant efficacy; It was evaluated by measuring thigh and calf diameters before and after treatment, whether there was recanalization in Doppler USG (recanalization> 75%), recanalization time, bleeding side effects and recovery times with treatment, and recurrence rates. The data were analyzed statistically using a statistics program.

Results: A significant difference was found when the mean thigh diameter measurements measured at the beginning of the treatment (Mean ± SD: 75,41) and the mean thigh diameter measured after the treatment (Mean ± SD: 54,63) were compared. P <0.05. A significant difference was found when the mean calf diameter measurements (Mean ± SD: 43.99) measured at the beginning of the treatment and the mean calf diameter measured after the treatment were compared. P <0.05. Post-treatment Doppler USG showed complete recanalization rate in 54% (75 patients) at 3 months and 25% (35 patients) at 6 months. At the end of the 6th month, the total recanalization rate occurred in 80% (110) patients.

Conclusion: New oral anticoagulants (rivaroxaban, dabigatran, apixaban, edoxaban) are very effective in the treatment of lower extremity deep venous thrombosis, both in providing recanalization and in terms of clinical improvement. There were acceptable side effects in accordance with the literature.

References

  • 1- Rosendal FR. Risk factors for venous thrombosis: prevalence, risk, and interaction. Semin Hematol.1997;34(3):171-87.
  • 2- Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1): 9-16.
  • 3- Wells P, Forgie MA, Rodger MA. Treatment of venous thromboembolism JAMA. 2014;311(7):717-28.
  • 4- Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. Journal of Blood Medicine. 2011;2:59-69. DOI: 10.2147/JBM.S19009
  • 5- Kurtoglu MH, Sivrikoz E. Derin ven trombozu: tanı, tedavi, proflaksi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2008;58(1):34-42.
  • 6- Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6. 358(10):1037-52.
  • 7- Meignan M, Rosso J, Gauthier H, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000 Jan 24. 160(2):159-64)
  • 8- Konstantinides SV, Meyer G, Becattini C et al. 2019 Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).European Heart Journal 2019;00:1-61 DOI:10.1093/eurheartj/ehz405
  • 9- Antithrombotic Therapy and Prevention of Thrombosis, 9th ed. American College of Chest Physician Evidence-based Clinical Practical Guidelines. Chest. 2012((2 Suppl);41 :7-47. DOI: 10.1378/chest.1412S3.
  • 10- Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123(12):1794-801.
  • 11- Tekin G.Current Treatments of Deep Venous Thrombosis. Archives Medical Review Journal.2015;24(4):415-431.
  • 12- Farzana Bacchus, Sam Schulman. Clinical Experience With the New Oral Anticoagulants for Treatment of Venous Thromboembolism. Arterioscler Thromb Vasc Biol. 2015 Mar;35(3):513-9.
  • 13- Lippi G., Favaloro E.J, Franchini M, Dangers in the practice of defensive medicine in hemostasis testing for investigation of bleeding or thrombosis: part I--routine coagulation testing, Semin. Thromb. Hemost., 2014, 40(7), 812-824.
  • 14- Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, et al., Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies, Thromb. J., 2013,11(1), 25.
  • 15- Farge D., Bounameaux H., Brenner B., Cajfinger F., Debourdeau P., Khorana A.A., et al., International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer, Lancet Oncol., 2016, 17(10), e452-e66.
  • 16- Harper P, Young L, Merriman E. Bleeding risk with dabigatran in the frail elderly. N Engl J Med. 2012;366(9):864-6.
  • 17- Van Es N, Coppens M, Schulman S, Middeldorp S, Büller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014; 124(12): 1968-75.
  • 18- Massimo Franchini, Pier Mannuccio Mannucci. Direct oral anticoagulants and venous thromboembolism.Eur Respir Rev 2016; 25(141): 295–302.

Alt Ekstremite Venöz Tromboz Tedavisinde Yeni Oral Antikoagulanların Etkinliği: Retrospektif Klinik Çalışma

Year 2021, Volume: 13 Issue: 2, 312 - 318, 07.06.2021
https://doi.org/10.18521/ktd.807493

Abstract

Amaç: Bu klinik çalışma alt ekstremite derin ven trombozu nedeniyle yeni oral antikoagulan ilaç (rivaroksaban, dabigatran,apiksaban, edoksaban) kullanan 138 hastanın retrospektif olarak incelenmesini içermektedir. Hastaların demografik özellikleri ile hastalık ilişkisi, tedavi başlangıç- bitiş süreleri, radyolojik ve klinik iyileşme durumları, yeni oral antikoagulanların yan etkileri değerlendirilmiştir.

Metod: Retrospektif çalışmaya yeni oral antikoagulan ilaç kullanan 138 hasta dahil edildi. Hastaların demografik özellikleri, tanı ve tedavi şemaları, radyolojik görüntüleri, epikriz notları kayıt edildi. Her bir hastanın kayıtları takip edildikleri 12 ay boyunca incelendi. Yeni oral antikoagulan etkinliği; tedavi öncesi ve sonrası uyluk ve baldır çaplarının ölçülmesi, doppler USG’de rekanalizasyon olup olmadığı (rekanalizasyon>%75), rekanalizasyon süresi, kanama yan etkileri ve tedavi ile iyileşme süreleri, rekürrens oranları ölçülerek değerlendirildi. Veriler istatistik programı kullanılarak istatiksel olarak incelendi.

Bulgular: Tedavi başlangıcında ölçülen uyluk çap ölçümleri ortalaması (Ort±SS:75,41 ) ile tedavi sonrası ölçülen uyluk çap ortalaması (Ort±SS:54,63) karşılaştırıldığında anlamlı fark bulundu. P<0.05. Tedavi başlangıcında ölçülen baldır çap ölçümleri ortalamaları (Ort±SS:43,99) ile tedavi sonrası ölçülen baldır çap ortalaması karşılaştırıldığında anlamlı fark bulundu. P<0.05.Hastalarda tedavi sonrası doppler USG de tam rekanalizasyon oranı 3.ayda % 54 (75 hasta) ,6 ayda % 25 (35 hasta) da görüldü.6.ay sonunda toplam rekanalizasyon oranı %80 (110) hastada gerçekleşmiştir.

Sonuç: Yeni oral antikoagulanlar (rivaroksaban, dabigatran,apiksaban, edoksaban) alt ekstremite derin venöz tromboz tedavisinde hem rekanalizasyonun sağlanmasında hem klinik düzelme anlamında oldukça etkilidir. Kabul edilebilir ve literatürle uyumlu oranda yan etkileri görülmüştür.

References

  • 1- Rosendal FR. Risk factors for venous thrombosis: prevalence, risk, and interaction. Semin Hematol.1997;34(3):171-87.
  • 2- Anderson FA, Spencer FA. Risk factors for venous thromboembolism. Circulation. 2003;107(23 Suppl 1): 9-16.
  • 3- Wells P, Forgie MA, Rodger MA. Treatment of venous thromboembolism JAMA. 2014;311(7):717-28.
  • 4- Kesieme E, Kesieme C, Jebbin N, Irekpita E, Dongo A. Deep vein thrombosis: a clinical review. Journal of Blood Medicine. 2011;2:59-69. DOI: 10.2147/JBM.S19009
  • 5- Kurtoglu MH, Sivrikoz E. Derin ven trombozu: tanı, tedavi, proflaksi. Harran Üniversitesi Tıp Fakültesi Dergisi. 2008;58(1):34-42.
  • 6- Tapson VF. Acute pulmonary embolism. N Engl J Med. 2008 Mar 6. 358(10):1037-52.
  • 7- Meignan M, Rosso J, Gauthier H, et al. Systematic lung scans reveal a high frequency of silent pulmonary embolism in patients with proximal deep venous thrombosis. Arch Intern Med. 2000 Jan 24. 160(2):159-64)
  • 8- Konstantinides SV, Meyer G, Becattini C et al. 2019 Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS).European Heart Journal 2019;00:1-61 DOI:10.1093/eurheartj/ehz405
  • 9- Antithrombotic Therapy and Prevention of Thrombosis, 9th ed. American College of Chest Physician Evidence-based Clinical Practical Guidelines. Chest. 2012((2 Suppl);41 :7-47. DOI: 10.1378/chest.1412S3.
  • 10- Kearon C, Akl EA. Duration of anticoagulant therapy for deep vein thrombosis and pulmonary embolism. Blood. 2014;123(12):1794-801.
  • 11- Tekin G.Current Treatments of Deep Venous Thrombosis. Archives Medical Review Journal.2015;24(4):415-431.
  • 12- Farzana Bacchus, Sam Schulman. Clinical Experience With the New Oral Anticoagulants for Treatment of Venous Thromboembolism. Arterioscler Thromb Vasc Biol. 2015 Mar;35(3):513-9.
  • 13- Lippi G., Favaloro E.J, Franchini M, Dangers in the practice of defensive medicine in hemostasis testing for investigation of bleeding or thrombosis: part I--routine coagulation testing, Semin. Thromb. Hemost., 2014, 40(7), 812-824.
  • 14- Wang Y, Wang C, Chen Z, Zhang J, Liu Z, Jin B, et al., Rivaroxaban for the treatment of symptomatic deep-vein thrombosis and pulmonary embolism in Chinese patients: a subgroup analysis of the EINSTEIN DVT and PE studies, Thromb. J., 2013,11(1), 25.
  • 15- Farge D., Bounameaux H., Brenner B., Cajfinger F., Debourdeau P., Khorana A.A., et al., International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer, Lancet Oncol., 2016, 17(10), e452-e66.
  • 16- Harper P, Young L, Merriman E. Bleeding risk with dabigatran in the frail elderly. N Engl J Med. 2012;366(9):864-6.
  • 17- Van Es N, Coppens M, Schulman S, Middeldorp S, Büller HR. Direct oral anticoagulants compared with vitamin K antagonists for acute venous thromboembolism: evidence from phase 3 trials. Blood 2014; 124(12): 1968-75.
  • 18- Massimo Franchini, Pier Mannuccio Mannucci. Direct oral anticoagulants and venous thromboembolism.Eur Respir Rev 2016; 25(141): 295–302.
There are 18 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Articles
Authors

Ekin İlkeli 0000-0003-0302-4721

Ali Cemal Düzgün 0000-0003-0491-913X

Publication Date June 7, 2021
Acceptance Date April 21, 2021
Published in Issue Year 2021 Volume: 13 Issue: 2

Cite

APA İlkeli, E., & Düzgün, A. C. (2021). The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study. Konuralp Medical Journal, 13(2), 312-318. https://doi.org/10.18521/ktd.807493
AMA İlkeli E, Düzgün AC. The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study. Konuralp Medical Journal. June 2021;13(2):312-318. doi:10.18521/ktd.807493
Chicago İlkeli, Ekin, and Ali Cemal Düzgün. “The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study”. Konuralp Medical Journal 13, no. 2 (June 2021): 312-18. https://doi.org/10.18521/ktd.807493.
EndNote İlkeli E, Düzgün AC (June 1, 2021) The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study. Konuralp Medical Journal 13 2 312–318.
IEEE E. İlkeli and A. C. Düzgün, “The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study”, Konuralp Medical Journal, vol. 13, no. 2, pp. 312–318, 2021, doi: 10.18521/ktd.807493.
ISNAD İlkeli, Ekin - Düzgün, Ali Cemal. “The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study”. Konuralp Medical Journal 13/2 (June 2021), 312-318. https://doi.org/10.18521/ktd.807493.
JAMA İlkeli E, Düzgün AC. The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study. Konuralp Medical Journal. 2021;13:312–318.
MLA İlkeli, Ekin and Ali Cemal Düzgün. “The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study”. Konuralp Medical Journal, vol. 13, no. 2, 2021, pp. 312-8, doi:10.18521/ktd.807493.
Vancouver İlkeli E, Düzgün AC. The Effectiveness of New Oral Anticoagulants in the Treatment of Lower Extremity Venous Thrombosis: A Retrospective Clinical Study. Konuralp Medical Journal. 2021;13(2):312-8.