Outcomes after Rivaroxaban Treatment of Extensive Deep Vein Thrombosis

Shunichiro Fujioka,Tadashi Kitamura,Fumiaki Shikata,Toshiaki Mishima,Yoshihiko Onishi,Haruna Araki,Hiroshi Goto,Akihiro Sasahara,Masaomi Fukuzumi,Shinzo Torii,Kagami Miyaji

doi:10.1016/j.avsg.2022.02.019

Shunichiro Fujioka, Tadashi Kitamura + Show 9 more

Open Access

https://doi.org/10.1016/j.avsg.2022.02.019

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Journal: Annals of Vascular Surgery	Publication Date: Mar 11, 2022
Citations: 1	License type: cc-by

Affiliation: Kitasato University

Abstract

Regression of thrombus in response to treatment with direct oral anticoagulants (DOACs) in patients with extensive deep vein thrombosis (DVT) has not been fully evaluated. This study aimed to determine the therapeutic efficacy of rivaroxaban in the treatment of extensive DVT. We retrospectively evaluated 76 patients treated with rivaroxaban among 728 new DVT patients, at our hospital from January 2018 to March 2021. Extensive DVT was defined as thrombus connecting to 2 or more segments of the inferior vena cava (IVC), iliac vein, femoral vein, or popliteal vein. Localized DVT was defined as a thrombus confined to 1 segment of the inferior vena cava (IVC), iliac vein, femoral vein, or popliteal vein. We compared the changes in thrombus between the extensive DVT group (36 patients) and the localized DVT group (40 patients). In the localized DVT group, 14 (37%) had total recanalization within 3weeks after DOAC initiation, and 30 (79%) had total recanalization within 3months. In the extensive DVT group, only 3 (9%) had total recanalization within 3weeks after starting DOAC, and even after 3months, only 5 (15%) had total recanalization. Symptoms (P=0.01) and extensive DVT (P<0.01) were significantly associated with the risk for failure of total recanalization. Rivaroxaban was highly effective for total recanalization of localized DVT but not for symptomatic or extensive DVT. In patients with symptomatic extensive DVT, catheter-based thrombolysis may be considered in selected cases.

Highlights

Since the approval of edoxaban for the treatment of deep vein thrombosis (DVT) in Japan in September 2014, direct oral anticoagulants (DOACs) have widely become used to treat DVT
The EINSTEIN trial for rivaroxaban and the AMPLIFY trial for apixaban reported no association between the initial degree of thrombosis and treatment response, which suggested that DOACs may be effective in treating a wide range of patients with DVT
More symptomatic cases occurred in the extensive DVT group (P 1⁄4 0.007), and fewer cases occurred after orthopedic surgery in the extensive DVT group (P 1⁄4 0.004)

Summary

Introduction

Since the approval of edoxaban for the treatment of deep vein thrombosis (DVT) in Japan in September 2014, direct oral anticoagulants (DOACs) have widely become used to treat DVT. The EINSTEIN trial for rivaroxaban and the AMPLIFY trial for apixaban reported no association between the initial degree of thrombosis and treatment response, which suggested that DOACs may be effective in treating a wide range of patients with DVT. Regression of thrombus in response to treatment with direct oral anticoagulants (DOACs) in patients with extensive deep vein thrombosis (DVT) has not been fully evaluated. Extensive DVT was defined as thrombus connecting to 2 or more segments of the inferior vena cava (IVC), iliac vein, femoral vein, or popliteal vein. Localized DVT was defined as a thrombus confined to 1 segment of the inferior vena cava (IVC), iliac vein, femoral vein, or popliteal vein. In patients with symptomatic extensive DVT, catheter-based thrombolysis may be considered in selected cases

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