Anticoagulant Therapy and Catheter-directed Thrombolysis: Effect on the Severity of Postthrombotic Syndrome in the Long Term in Patients with Deep Vein Thrombosis of the Lower Limbs

Abstract

Introduction: The results of studies comparing the effectiveness of anticoagulant therapy and catheter-directed thrombolysis for the prevention of postthrombotic syndrome (PTS) in the long-term period after deep vein thrombosis of lower limbs (DVT) remain controversial and the issue of choosing a treatment method has not been finally resolved. Methods: We studied 128 patients with DVT. 102 of them were getting conservative treatment (23 patients - heparin and warfarin, 40 patients - rivaroxaban, 39 - heparin and dabigatran), 26 patients were getting catheter-directed thrombolysis procedure followed by prescribing rivaroxaban. We were measuring venous insuffiency by the Villalta scale on the 1 day, after 4 days and in 1, 6 and 12 months from the start of treatment. Comparison of patients after 1 and 6 months from the start of treatment was carried out only between patients taking different anticoagulants. Results: On the first day of treatment the Kruskal-Wallis test didn't show a statistically significant difference in the incidence rate in patients in the comparison groups. The index of patients in the “Warfarin” group was 12 points (95% CI [8, 18]), “Rivaroxaban”-14 points (95%CI[12,16]), and “Dabigatran”-16 points(95%CI[16,18]) and “Thrombolysis”-15.5 points(95%CI[12,18]) on the Villalta scale(Kruskal-Wallis chi-square=4.345, df=3, p-value=0.2265).On the 4th day,the intensity of venous insufficiency in patients who received conservative treatment was higher than in patients undergoing catheter-directed thrombolysis(the duration of thrombolysis did not exceed more than 3 days):“Warfarin”patients had 10 points (95% CI [6, 12]), “Rivaroxaban” - 8 points (95% CI [6, 8]), “Dabigatran” - 10 points (95% CI [8, 12])) and “Thrombolysis” - 5 points (95% CI [4, 7], W=0.91873,p=0.008999). When comparing the dynamics of changes in venous insufficiency using the Kruskal-Wallis test in patients who received conservative therapy after 30 days (Kruskal-Wallis chi-square = 1.1123, df = 2, p-value = 0.5734) and 6 months (Kruskal-Wallis chi-square = 0.3067, df = 2, p-value = 0.8578) there were no statistically significant differences between subgroups of patients taking different anticoagulants. After 1 year the intensity of venous insufficiency was evaluated in all patients who received conservative and surgical treatment. The following results were obtained: the severity of venous insufficiency in patients of the “Warfarin”group is 3.5 points(95% CI [0,6]), “Rivaroxaban”-2 points(95% CI [0,5]), “Dabigatran”-5 points (95% CI [2,5]) and “Thrombolysis” - 3 points (95% CI [2, 4,5]), however, there were no statistically significant differences in venous insufficiency indicators in patients and groups, subgroups of groups of conservative treatment(Kruskal-Wallis chi-square = 4.7438,df=3, p-value=0.1915). Conclusion: 1.Catheter-directed thrombolysis performed by a patient with deep vein thrombosis of the lower limbs faster reduces intensity of venous insufficiency if compare it with standard conservative therapy. 2.After 1 year, regardless of the type of treatment of patients with deep vein thrombosis of the lower limbs (conservative treatment or catheter-directed thrombolysis), there were no statistically differences between the severity of postthrombotic syndrome between the patients of both groups. Disclosure: Nothing to disclose