Anticoagulation efficacy in patients with acute deep vein thrombosis of the lower extremities
DOI:
https://doi.org/10.11603/2414-4533.2020.2.10769Keywords:
deep vein thrombosis, anticoagulant therapy, recurrence, D-dimer, residual vein obstructionAbstract
The aim of the work: to estimate the risk of deep vein thrombosis (DVT) recurrence by determining the degree of residual vein obstruction and the value of the D-dimer level at the end of anticoagulation.
Materials and Methods. There were examined and treated 98 patients with deep vein thrombosis of various locations. Patients were observed during anticoagulation therapy (n-98) and after its performance (n-76) for between 7 and 120 months. Depending on the scheme of anticoagulation therapy patients were divided into three groups: group 1 (32) received Warfarin, group 2 (34) – Rivaroxaban, group 3 (32) – Dabigatran Etexilate. To all patients were verify the diagnosis and monitoring of the therapy, ultrasonographic examination was conducted and evaluated the D-dimer levels.
Results and Discussion. In terms of initial and long-term anticoagulant therapy, regardless of the choice of treatment regimens, DVT recurrence or pulmonary embolism cases we did not observed. After the treatment, during the first year, recurrence of DVT was more frequent in patients of all groups. In patients of the group 1 their frequency was (15.38±7.08) %, group 2 – (8.7±5.88) %, group 3 – (3.7±3.63) %, which did not differ significantly (p=0.33). In general, the overall observation period showed a recurrence rate among the patients of group 1 was 10 cases, 4 cases in group 2, and three cases in group 3 (p<0.05). There was no significant difference in the incidence of thrombosis recurrence was observed between patients taking rivaroxaban and dabigatran etexilate, whereas there was a significant difference between the 1 and 3 groups (p<0.05). By the end of treatment patients with DVT, positive results restoration of patency of veins and significance of D-dimer <500 ng/ml – were detected in 2 times more often in patients receiving the novel oral anticoagulants (NOAC). This explains the low percentage of recurrence in the groups 2 and 3 compared to group 1 where patients received antagonist vitamin K. Elevated levels of D-dimer> 500 ng/ml at the time of completion of anticoagulation is a risk factor for relapse in patients with DVT, as well as residual obstruction of veins. Long-term anticoagulation with warfarin is the least predictable as for the risk of recurrence of DVT (p<0.05), when the application of Rivaroxaban and dabigatran etexilate showed no significant difference in the incidence of DVT recurrence.
References
Hudz, I.M., & Hudz, O.I. (2016). Problemy retsedyvu trombozu hlybokykh ven nyzhnikh kintsivok u svitli dokazovoi medytsyny [Problems of thrombosis recurrence of deep veins of lower extremities in the light of evidence-based medicine]. Halytskyi likarskyi visnyk – Galician Doctor’s Bulletin, 3 (3) (part1), 72-74 [in Ukrainian].
Baglin, T., Bauer, K., Douketis, J., Buller, H., Srivastava, A., & Johnson, G., et al. (2012). Duration of anticoagulant therapy after a first episode of an unprovoked pulmonary embolus or deep vein thrombosis: Guidance from the SSC of the ISTH. J. Thromb. Haemost., 10, 698-702. DOI: https://doi.org/10.1111/j.1538-7836.2012.04662.x
Kearon, C., Akl, E.A., & Ornelas, J. (2016). Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest, 149, 315-352. DOI: https://doi.org/10.1016/j.chest.2015.11.026
Iorio, A., Kearon, C., & Filippucci, E. (2010). Risk of recurrence after a first episode of symptomatic venous thromboembolism provoked by a transient risk factor: a systematic review. Arch. Intern. Med., 170, 1710-1716. DOI: https://doi.org/10.1001/archinternmed.2010.367
Kyrle, P.A., Kammer, M., & Eischer, L. (2016). The long-term recurrence risk of patients with unprovoked venous thromboembolism: an observational cohort study. J. Thromb. Haemost., 14, 2402-2409. DOI: https://doi.org/10.1111/jth.13524
Kearon, C., Parpia, S., Spencer, F.A., Schulman, S., Stevens, S.M., Shah, V., Bauer, K.A., Douketis, J.D., Lentz, S.R., Kessler, C.M., & Connors, J.M. (2019). Long term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to D-dimer results; a cohort study. Journal of Thrombosis and Haemostasis, (17), 1144-1152. DOI: https://doi.org/10.1111/jth.14458
Cosmi, B., Legnani, C., & Tosetto, A. (2010). PROLONG Investigators (on behalf of Italian Federation of Anticoagulation Clinics). Lsefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked v venous thromboembolism: the PROLONG II prospective study. Blood, 115, 481-488. DOI: https://doi.org/10.1182/blood-2009-08-237354
Siragusa, S., Malato, A., & Anastasio, R. (2008). Residual vein thrombosis to establish duration of anticoagulation after a first episode of deep vein thrombosis: the Duration of Anticoagulation based on Compression UltraSonography (DACUS) study. Blood, 112 (3), 511-515. DOI: https://doi.org/10.1182/blood-2008-01-131656
Prandoni, P., Prins, M.H., & Lensing, A.W. (2009). AESOPUS Investigators. Residual thrombosis on ultrasonography to guide the duration of anticoagulation in patients with deep venous thrombosis: a randomized trial. Ann. Intern. Med., 150, 577-585. DOI: https://doi.org/10.7326/0003-4819-150-9-200905050-00003
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