Comparative efficacy of long-term anticoagulation in patients with iliofemoral acute deep vein thrombosis treated with pharmaco-mechanical catheter-directed thrombolysis

Öz

Aim: We aimed to compare the stability of pharmacologic profile, rate of symptomatic recurrent venous thromboembolism, major bleeding and the net clinical benefit on the regimen with vitamin K antagonist (VKA), low molecular weight heparin (LMWH) and direct oral anticoagulant (DOAC) for long-term anticoagulation in patients undergoing pharmaco-mechanical catheter-directed thrombolysis (PMCDT) for the treatment of deep vein thrombosis (DVT). Material and Methods: During the period from January 2019 until June 2019, data of 112 patients who underwent PMCDT for the treatment of acute iliofemoral DVT in our institution with long-term apixaban (Pfizer, Turkey) medication were prospectively collected (Group 1-DOAC). Data of control groups within January 2017- December 2018 period were collected retrospectively. Control groups consisted of PMCDT patients with extended LMWH (Tinzaparin, Abdi Ibrahim Pharma, Turkey) treatment (Group 2-LMWH; N=119) and with VKA (Coumadin, Eczacibasi Pharma, Turkey) treatment (Group 3- Control; N=111). Results: Patients treated with VKA showed a significant incompliance starting from third month up to one year. Patency rate diminished significantly below 70%. 32% of VKA patients were out of therapeutic range even in the first month leading to 40% at the end of the year. Likert Scale, Villalta/VCCS and VEINES-QOL-Sym scores confirmed the clinical data. Conclusion: This study highlights the potential role of DOAC as a reasonable alternative to VKAs/LMWH in the long-term anticoagulation strategy for DVT. We await larger clinical trials to support these findings and establish the role of DOAC as the standard of care for patients with DVT.

Anahtar Kelimeler

• deep vein thrombosis
• venous thromboembolism
• pharmaco-mechanical catheter-directed thrombolysis
• vitamin k antagonists
• low molecular weight heparin
• direct oral anticoagulants

Farmakomekanik katater aracılı tromboliz ile tedavi edilen akut ilyofemoral derin ven trombozlu hastalarda uzun süreli antikoagülasyonun karşılaştırmalı etkinliği

Öz

Amaç: Derin ven trombozu (DVT) tedavisi için farmakomekanik katater aracılı trombliz (FMKAT) yapılan hastalarda; vitamin K antagonistlerini(VKA), düşük molekül ağırlıklı heparini (DMAH) ve direk oral antikoagülan ajanları (DOAK) farmakolojik profilllerinin stabilitesine, semptomatik rekürren venöz tromboembolik, major kanama ve klinik fayda oranlarına göre karşılaştırmayı hedefledik. Gereç ve Yöntemler: Ocak 2019 ile Haziran 2019 tarihleri arasında kliniğimizde akut iliofemoral DVT tanısı ile FMKAT yapılan ve uzun dönemde apixaban (Pfizer, Türkiye) tedavisi ile takip edilen 112 hastanın verileri toplandı. (Grup 1- DOAK) Kontrol gruplarının dataları ise Ocak 2017 ile Aralık 2018 tarihleri arasında yine kliniğimizde akut iliofemoral DVT tanısı ile FMKAT yapılan ve uzun dönemde DMAH (Tinzaparin, Abdi Ibrahim İlaç, Türkiye) tedavisi (Group 2-DMAH; N=119) ve VKA(Coumadin, Eczacibasi İlaç, Türkiye) tedavisi (Grup 3- Kontrol N=111) hastalardan toplandı. Bulgular: VKA tedavisi ile takip edilen hastalarda 3.aydan başlayıp 1 yıla kadar ki takip sürelerinde belirgin oranda tedaviye uyumsuzluk saptandı. Patens oranları %70'in altındaydı. VKA hastalarının %32'si yıl sonunda terapötik dozlarda değildi. Likert skalaları, Villalta/VCCS ve VEINES-QOL-Sym skorlama sistemlerinin sonuçları klinik sonuçlar ile uyumluydu. Sonuç :Bu çalışma DOAK'ların DVT hastalarında tedavi için DMAH ve VKA'lara mantıklı bir alternatif seçenek olduğunu gösterdi. DOAK tedavisinin DVT hastalarında standart bir tedavi olarak tercih edilebilmesi için bizim elde ettiğimiz sonuçları destekleyecek geniş kapsamlı klinik çalışmaların sonuçları beklenmektedir

Anahtar Kelimeler

• derin ven trombozu
• venöz tromboembolizm
• farmakomekanik katater araçılı tromboliz
• vitamin k antagonistleri
• düşük molekül ağırlıklı heparin
• direk oral antikoagülanlar

Kaynakça

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