FEATURES OF TREATMENT OF VENOUS THROMBOEMBOLISM IN MODERN CONDITIONS
DOI:
https://doi.org/10.11603/1811-2471.2023.v.i1.13557Keywords:
venous thromboembolism, catheter-directed thrombolysis, thrombectomy, coffee filtersAbstract
SUMMARY. Treatment of venous thromboembolism today remains a complex and controversial problem.
The aim – to analyze the results of the treatment of patients with venous thromboembolism, compare them with global data, and form a treatment strategy based on this.
Material and methods. Our study analyzed the results of treatment of 1,297 patients with venous thromboembolism who underwent inpatient treatment at the Vinnytsia Regional Clinical Hospital named after E. Pirogov for the period from 2009 to 2022.
The average length of stay in the hospital was 9.32 days. Floating thrombosis was observed in 75 (5.5 %) patients.
There were 725 (55.9 %) men, 572 (44.1 %) women.
Results. During the study period, clinical improvement was noted in 95 % of patients. Embolism in the temporary coffee filter was noted in 4 cases. There was no case of fatal PE after treatment in the studied group. There was no case of massive bleeding after the use of thrombolytic therapy. There were no recurrent PE during treatment in the clinic.
Conclusions. Thus, taking into account the results of our study, we can conclude that the treatment of venous thromboembolism is a multifaceted problem that requires an individual approach to each patient. In the treatment of venous thromboembolism, it is necessary to apply the entire range of possible treatment methods, based on the nature of thrombosis, the functional state of the patient, the time since the onset of the disease, the severity of the clinical picture. At the same time, the arsenal of doctors should include both methods of conservative therapy, as well as CST techniques, surgical methods and minimally invasive modern technologies.
References
Heit, J.A., Spencer, F.A., & White, R.H. (2016). The epidemiology of venous thromboembolism. J. Thromb. Thrombolysis, 41, 3-14. DOI: https://doi.org/10.1007/s11239-015-1311-6
Spencer, F.A., Emery, C., Joffe, S.W., Pacifico, L., Lessard, D., & Reed, G. (2009). Incidence rates, clinical profile, and outcomes of patients with venous thromboembolism. The Worcester VTE study. J. Thromb. Thrombolysis; 28, 401-409. DOI: https://doi.org/10.1007/s11239-009-0378-3
Silverstein, M.D., Heit, J.A., Mohr, D.N., Petterson, T.M., O’Fallon, W.M., & Melton III, L.J. (1998). Trends in the incidence of deep vein thrombosis and pulmonary embolism: a 25-year population-based study. Arch. Intern. Med.,158, 585e93. DOI: https://doi.org/10.1001/archinte.158.6.585
Wendelboe, A.M., & Raskob, G.E. (2016). Global burden of thrombosis: epidemiologic aspects. Circ. Res., 118, 1340-1347. DOI: https://doi.org/10.1161/CIRCRESAHA.115.306841
White, R.H. (2003). The epidemiology of venous thromboembolism. Circulation, 107, 4-8. DOI: https://doi.org/10.1161/01.CIR.0000078468.11849.66
Cohen, A.T., Agnelli, G., Anderson, F.A., Arcelus, J.I., Bergqvist D., Brecht J.G., … Spannagl, M. (2007). VTE Impact Assessment Group in Europe (VITAE). Venous thromboembolism (VTE) in Europe. The number of VTE events and associated morbidity and mortality. Thromb. Haemost., 98, 756-764. DOI: https://doi.org/10.1160/TH07-03-0212
Beckman, M.G., Hooper, W.C., & Critchley, S.E. (2010). Venous thromboembolism: a public health concern. Am. J. Prev. Med., 38, S495-501. DOI: https://doi.org/10.1016/j.amepre.2009.12.017
Prandoni, P., Lensing, A.W., & Prins, M.H. (2004). Belowknee elastic compression stockings to prevent the postthrombotic syndrome: a randomized, controlled trial. Ann. Intern. Med., 141, 249-256. DOI: https://doi.org/10.7326/0003-4819-141-4-200408170-00004
Kakkos, S. K., Gohel, M., Baekgaard, N., Bauersachs, R. , Bellmunt-Montoya, S., Black, S.A., … Stansby, G. (2021). European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur. J. Vasc. Endovasc. Surg., 61, 9-82. DOI: https://doi.org/10.1016/j.ejvs.2020.09.023
Othieno, R., Okpo, E., & Forster, R. (2018). Home versus in-patient treatment for deep vein thrombosis. Cochrane Database Syst. Rev., 1(1), CD003076. DOI: https://doi.org/10.1002/14651858.CD003076.pub3
Erkens, P.M., & Prins, M.H. (2010). Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst. Rev., 9, CD001100. DOI: https://doi.org/10.1002/14651858.CD001100.pub3
Dolovich, L.R., Ginsberg, J.S., Douketis, J.D., Holbrook, A.M., & Cheah, G. (2000). A meta-analysis comparing low-molecular-weight heparins with unfractionated heparin in the treatment of venous thromboembolism: examining some unanswered questions regarding location of treatment, product type, and dosing frequency. Arch. Intern. Med., 160(2), 181-188. DOI: 10.1001/archinte.160.2.181. DOI: https://doi.org/10.1001/archinte.160.2.181
Gould, M.K., Dembitzer, A.D., Sanders, G.D., & Garber, A.M. (1999). Low-molecular-weight heparins compared with unfractionated heparin for treatment of acute deep venous thrombosis. A cost-effectiveness analysis. Ann. Intern. Med., 130(10), 789-799. DOI: 10.7326/0003-4819-130-10-199905180-000. DOI: https://doi.org/10.7326/0003-4819-130-10-199905180-00002
van Dongen, C.J., van den Belt, A.G., Prins, M.H., & Lensing, A.W. (2004). Fixed dose subcutaneous low molecular weight heparins versus adjusted dose unfractionated heparin for venous thromboembolism. Cochrane Database Syst. Rev., 4, CD001100. DOI: 10.1002/14651858.CD001100.pub2.02. DOI: https://doi.org/10.1002/14651858.CD001100.pub2
Kearon, C., Akl, E.A., Comerota, A.J., Prandoni, P., Bounameaux, H., Goldhaber, S.Z., … Kahn, S.R. (2012). Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 141(2), e419S-e496S. DOI: 10.1378/chest.11-2301. DOI: https://doi.org/10.1378/chest.11-2301
Prins, M.H, Lensing, A.W., Bauersachs, R., van Bellen, B., Bounameaux, H., Brighton ,T.A., … Wells, P.S. (2013). EINSTEIN Investigators. Oral rivaroxaban versus standard therapy for the treatment of symptomatic venous thromboembolism: a pooled analysis of the EINSTEIN-DVT and PE randomized studies. Thromb. J., 11(1), 21. DOI: https://doi.org/10.1186/1477-9560-11-21
Kearon, C., Akl, E.A., Ornelas, J., Blaivas, A., Jimenez, D., Bounameaux, H., … Moores, L. (2016). Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest., 149(2), 315-352. DOI: 10.1016/j.chest.2015.11.026. Epub 2016 Jan 7. DOI: https://doi.org/10.1016/j.chest.2015.11.026
Konstantinides, S.V., Meyer, G., Becattini, C., Bueno, H., Geersing, G.J., Harjola, V.P., … Zamorano, J.L (2020). ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS). Eur. Heart J., 41(4), 543-603. DOI: https://doi.org/10.1093/eurheartj/ehz405
(2020). Venous thromboembolic diseases: diagnosis, management and thrombophilia testing. London: National Institute for Health and Care Excellence (NICE).
Kahn, S.R., Shbaklo, H., & Lamping, D.L. (2008). Determinants of health-related quality of life during the 2 years following deep vein thrombosis. J. Thromb. Haemost., 6, 1105-112. DOI: https://doi.org/10.1111/j.1538-7836.2008.03002.x
Henke, P.K., & Comerota, A.J. (2011). An update on etiology, prevention, and therapy of postthrombotic syndrome. J. Vasc. Surg., 53, 500-509. DOI: https://doi.org/10.1016/j.jvs.2010.08.050
Comerota, A.J., & Paolini, D. (2007). Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur. J. Vasc. Endovasc. Surg., 33(3), 351-360. Discussion 361-2. DOI: 10.1016/j.ejvs.2006.11.013. Epub 2006 Dec. 11. DOI: https://doi.org/10.1016/j.ejvs.2006.11.013
Plate, G., Eklof, B., Norgren L, Ohlin, P., & Dahlstrom, J.A. (1997). Venous thrombectomy for iliofemoral vein thrombosis–10-year results of a prospective randomised study. Eur. J. Vasc. Endovasc. Surg., 14, 367e74. DOI: https://doi.org/10.1016/S1078-5884(97)80286-9
Robertson L, McBride O, & Burdess A. (2016). Pharmacomechanical thrombectomy for iliofemoral deep vein thrombosis. Cochrane Database of Systematic Reviews, 11. CD011536. DOI: 10.1002/14651858.CD011536.pub2. DOI: https://doi.org/10.1002/14651858.CD011536.pub2
Suwanabol, P.A., & Hoch J.R. (2013). Venous thromboembolic disease. Surgical Clinics of North America, 93(4), 983-995. DOI: https://doi.org/10.1016/j.suc.2013.05.003
Goldhaber, S.Z., Meyerovitz, M.F., & Green, D. (1990). Randomized controlled trial of tissue plasminogen activator in proximal deep venous thrombosis. Am. J. Med., 88, 235-240. DOI: https://doi.org/10.1016/0002-9343(90)90148-7
Turpie, A.G., Levine, M.N., & Hirsh, J. (1990). Tissue plasminogen activator (rt-PA) vs heparin in deep vein thrombosis. Results of a randomized trial. Chest, 97, 172s-175s. DOI: https://doi.org/10.1378/chest.97.4_Supplement.172S
Watson, L., Broderick, C., & Armon, M.P. (2014). Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst. Rev., 1, CD002783. DOI: https://doi.org/10.1002/14651858.CD002783.pub3
Albers, G.W., Bates, V.E., & Clark, W.M. (2000). Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA, 283, 1145-1150.
Miller, D.J., Simpson, J.R., Silver, B. (2011). Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies. Neurohospitalist, 1, 138-147.
Fleck, D., Albadawi, H., Shamoun, F., Knuttinen, G., Naidu, S.,& Oklu, R. (2017). Catheter-directed thrombolysis of deep vein thrombosis: literature review and practice considerations. Cardiovasc. Diagn. Ther., 7(3), S228-S237. DOI: 10.21037/cdt.2017.09.15. DOI: https://doi.org/10.21037/cdt.2017.09.15
Oklu, R., & Wicky, S. (2013). Catheter-directed thrombolysis of deep venous thrombosis. Semin. Thromb. Hemost. 39, 446-451. DOI: https://doi.org/10.1055/s-0033-1334142
Vedantham, S., Sista, A.K., & Klein, S.J., (2014). Quality improvement guidelines for the treatment of lowerextremity deep vein thrombosis with use of endovascular thrombus removal. J. Vasc. Interv. Radiol., 25, 1317-1325. DOI: https://doi.org/10.1016/j.jvir.2014.04.019
Mewissen, M.W., Seabrook, G.R., & Meissner, M.H. (1999). Catheter-directed thrombolysis for lower extremity deep venous thrombosis: report of a national multicenter registry. Radiology, 211, 39-49. DOI: https://doi.org/10.1148/radiology.211.1.r99ap4739
Comerota, A.J., Throm, R.C., & Mathias, S.D. (2000). Catheterdirected thrombolysis for iliofemoral deep venous thrombosis improves health-related quality of life. J. Vasc. Surg., 32, 130-137. DOI: https://doi.org/10.1067/mva.2000.105664
Aziz, F., & Comerota, A.J. (2012). Quantity of residual thrombus after successful catheter-directed thrombolysis for iliofemoral deep venous thrombosis correlates with recurrence. Eur. J. Vasc. Endovasc. Surg., 44, 210-213. DOI: https://doi.org/10.1016/j.ejvs.2012.04.016
Baekgaard, N., Broholm, R., & Just, S. (2010). Long-term results using catheter-directed thrombolysis in 103 lower limbs with acute iliofemoral venous thrombosis. Eur. J. Vasc. Endovasc. Surg., 39, 112-117. DOI: https://doi.org/10.1016/j.ejvs.2009.09.015
Albers, G.W., Bates, V.E., & Clark, W.M. (2000). Intravenous tissue-type plasminogen activator for treatment of acute stroke: the Standard Treatment with Alteplase to Reverse Stroke (STARS) study. JAMA, 283, 1145-1150. DOI: https://doi.org/10.1001/jama.283.9.1145
Miller, D.J., Simpson, J.R., & Silver, B. (2011). Safety of thrombolysis in acute ischemic stroke: a review of complications, risk factors, and newer technologies. Neurohospitalist, 1, 138-147. DOI: https://doi.org/10.1177/1941875211408731
Pisters, R., Lane, D.A., & Nieuwlaat, R. (2010). A novel userfriendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest, 138, 1093-1100. DOI: https://doi.org/10.1378/chest.10-0134
Ruiz-Gimenez, N., Suarez, C., & Gonzalez, R. (2008). Predictive variables for major bleeding events in patients presenting with documented acute venous thromboembolism. Findings from the RIETE Registry. Thromb. Haemost, 100, 26. DOI: https://doi.org/10.1160/TH08-03-0193
Enden, T., Haig, Y., Klow, N.E., Slagsvold, C.E., Sandvik, L., & Ghanima, W. (2012). Long-term outcome after additional catheter-directed thrombolysis versus standard treatment for acute iliofemoral deep vein thrombosis (the CaVenT study): a randomised controlled trial. Lancet, 379, 31e8. DOI: https://doi.org/10.1016/S0140-6736(11)61753-4
Vedantham, S., Goldhaber, S.Z., Julian, J.A., Kahn, S.R., Jaff, M.R., & Cohen, D.J. (2017). Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N. Engl. J. Med., 377, 2240e52.
Baekgaard, N., Klitfod, L., & Broholm, R. (2012). Safety and efficacy of catheter-directed thrombolysis. Phlebology, 27(1), 149e54. DOI: https://doi.org/10.1258/phleb.2012.012s15
Haig, Y., Enden, T., Grøtta, O., Kløw, N.E., Slagsvold, C.E., Ghanima, W., … Sandset, P.M. (2016). CaVenT Study Group. Post-thrombotic syndrome after catheter-directed thrombolysis for deep vein thrombosis (CaVenT): 5-year follow-up results of an open-label, randomised controlled trial. Lancet Haematol., 3(2), e64-71. DOI: 10.1016/S2352-3026(15)00248-3. Epub 2016 Jan 6. DOI: https://doi.org/10.1016/S2352-3026(15)00248-3
Vedantham, S., Goldhaber, S.Z., Julian, J.A., Kahn, S.R., Jaff, M.R., Cohen, D.J., … Kearon, C. (2017). ATTRACT Trial Investigators. Pharmacomechanical Catheter-Directed Thrombolysis for Deep-Vein Thrombosis. N. Engl. J. Med., 377(23), 2240-2252. DOI: 10.1056/NEJMoa1615066. DOI: https://doi.org/10.1056/NEJMoa1615066
Lichtenberg, M., Stahlhoff, W.F., Özkapi, A., de Graaf, R., & Breuckmann, F. (2019). Safety, Procedural Success and Outcome of the Aspirex ® S Endovascular Thrombectomy System in the Treatment of Iliofemoral Deep Vein Thrombosis - Data From the Arnsberg Aspirex Registry. Vasa, 48(4), 341-346. DOI: https://doi.org/10.1024/0301-1526/a000779
Rabuffi, P., Vagnarelli, S., Bruni, A., Gallucci, M., Ambrogi, C., Passaro, G., Flore, R. A., & Tondi, P. (2019). Pharmacomechanical Catheter-Directed Thrombolysis for Acute Iliofemoral Deep Vein Thrombosis: Our Case Series. Eur. Rev. Med. Pharmacol. Sci., 23(5), 2244-2252.
Khrebtiy, Y., & Chernukha, L. (2021). Is there a place for aggressive tactics in the treatment of deep vein thrombosis today? Clinical case of aspiration thrombectomy in the treatment of deep vein thrombosis. Acta Phlebologica, 22(2), 61-68. DOI: https://doi.org/10.23736/S1593-232X.20.00476-2
Heller, S., Lubanda, Jean-C., Varejka, P., Chochola, M., Prochazka, P., Rucka, D., … Linhart, A. (2017). Percutaneous Mechanical Thrombectomy Using Rotarex® S Device in Acute Limb Ischemia in Infrainguinal Occlusions. Biomed. Res. Int., 2017, 2362769. DOI: https://doi.org/10.1155/2017/2362769
Freitas, B., Steiner, S., Bausback, Y., Branzan, D., Ülrich, M., Bräunlich, S., Schmidt, A., & Scheinert D., (2017). Rotarex Mechanical Debulking in Acute and Subacute Arterial Lesions. Angiology, 68(3), 233-241. DOI: https://doi.org/10.1177/0003319716646682
Loffroy, R., Falvo, N., Guillen, K., Galland, Ch., Baudot, X., Demaistre, E., … Chevallier O., (2020). Single-Session Percutaneous Mechanical Thrombectomy Using the Aspirex ® S Device Plus Stenting for Acute Iliofemoral Deep Vein Thrombosis: Safety, Efficacy, and Mid-Term Outcomes. Diagnostics (Basel), 10(8), 544. DOI: https://doi.org/10.3390/diagnostics10080544
(2019). Percutaneous mechanical thrombectomy for acute deep vein thrombosis of the leg Interventional procedures guidance. London: National Institute for Health and Care Excellence (NICE).
Piazza, G., Hohlfelder, B., Jaff, M.R., Ouriel, K., Engelhardt, T.C., Sterling, K.M., … Goldhaber, S.Z. (2015). A prospective, single-arm, multicenter trial of ultrasound-facilitated, catheter-directed, lowdose fibrinolysis for acute massive and submassive pulmonary embolism: the SEATTLE II study. JACC Cardiovasc. Interv., 8, 13821392. DOI: https://doi.org/10.1016/j.jcin.2015.04.020
Tapson, V.F., Sterling, K., Jones, N., Elder, M., Tripathy, U., Brower, J., … Goldhaber, S.Z. (2018). A randomized trial of the optimum duration of acoustic pulse thrombolysis procedure in acute intermediate-risk pulmonary embolism: the OPTALYSE PE trial. JACC Cardiovasc. Interv. 11, 14011410. DOI: https://doi.org/10.1016/j.jcin.2018.04.008
Kuo, W.T., Banerjee, A., Kim, P.S., DeMarco, F.J. Jr., Levy, J.R., Facchini, F.R., … De Gregorio, M.A. (2015). Pulmonary Embolism Response to Fragmentation, Embolectomy, and Catheter Thrombolysis (PERFECT): initial results from a prospective multicenter Registry. Chest, 148, 667673. DOI: https://doi.org/10.1378/chest.15-0119
Norris, C.S, Greenfield, L.J, & Herrmann, J.B. (1985). Free-floating iliofemoral thrombus. A risk of pulmonary embolism. Arch. Surg., 120(7), 806-808. DOI: https://doi.org/10.1001/archsurg.1985.01390310044009
