Feasibility of anticoagulation using low molecular-weight heparin during catheter-directed thrombolysis for lower extremity deep venous thrombosis

Yonghui Li,Rongzhou He,Junwei Wang,Junmeng Zheng,Kai Huang,Chen Yao,Zhibo Chen

doi:10.1186/s12959-021-00260-3

Abstract

BackgroundThe optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT.MethodsThe clinical data of DVT patients who underwent CDT during the past six years was retrospectively collected and reviewed. Patients were divided into therapeutic-dose anticoagulation (TPDA) and sub therapeutic-dose anticoagulation (sub-TPDA) groups according to LMWH dosage.ResultsA total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving the iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloons, stents, and thrombectomy were provided for nine (14.8%), four (6.6%), and one (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rate was 2.5 (0.83 to 5) × 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 2.4 (0.6 to 10.80) × 106 U. During CDT, five (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolisms, or death occurred. Complete (> 90%) and partial thrombolysis (50 ~ 90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant differences in baseline characteristics, clinical improvement, thrombolysis results, and complications.ConclusionsAnticoagulation therapy using low molecular-weight heparin during CDT with low infusion rate for DVT is likely to be feasible and safe. Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for CDT with similar clinical outcome and bleeding complications.

Highlights

Deep venous thrombosis (DVT) is a common disease with an incidence of approximately 1 ~ 2 per 1000 persons per year [1]
Sub-therapeutic-dose anticoagulation and therapeutic-dose could be used for catheter-directed thrombolysis (CDT) with similar clinical outcome and bleeding complications
It is one of the major causes of pulmonary embolism (PE), which led to nearly 1 60,000 deaths in American during the period from 1998 to 2018 [2]

Summary

Introduction

Deep venous thrombosis (DVT) is a common disease with an incidence of approximately 1 ~ 2 per 1000 persons per year [1]. It is one of the major causes of pulmonary embolism (PE), which led to nearly 1 60,000 deaths in American during the period from 1998 to 2018 [2]. Catheter-directed thrombolysis (CDT) has been proposed for symptomatic patients with severe DVT, in the setting of phlegmasia alba dolens [6]. The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. This study was performed to evaluate the feasibility of anticoagulation therapy using low molecular-weight heparin (LMWH) during CDT for DVT

Methods

Results

Discussion

Conclusion