Feasibility of Anticoagulation using Low Molecular‑weight Heparin during Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

Abstract Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. The present study is performed to evaluate the effectiveness and safety of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients underwent CDT during the past 6 years were retrospectively collected and reviewed. According to LMWH dose, patients were divided into therapeutic-dose anticoagulation (TPDA) group and sub therapeutic-dose anticoagulation (sub-TPDA) group.Results: A 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 iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloon, stent and thrombectomy were provided for 9 (14.8%), 4 (6.6%) and 1 (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 rates was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 240 (60 to 1080) x 104 U. During CDT, 5 (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolism 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 difference in baseline characteristics, clinical improvement, thrombolysis results and complications.Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT for DVT is effective and safe. In comparison with sub-therapeutic-dose anticoagulation, therapeutic-dose did not improve the thrombolytic effect or increase the rate of complication.

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Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

10.21203/rs.3.rs-42400/v2 ◽

2020 ◽

Author(s):

Yonghui Li ◽

Junwei Wang ◽

Rongzhou He ◽

Junmeng Zheng ◽

Zhibo Chen ◽

...

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Therapeutic Dose ◽

Infusion Rate ◽

Low Molecular Weight Heparin ◽

Anticoagulation Therapy ◽

Bleeding Complications ◽

Low Molecular Weight ◽

Catheter Directed Thrombolysis

Abstract Background: 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: The 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.Results: A 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) x 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) x 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 difference in baseline characteristics, clinical improvement, thrombolysis results, and complications. Conclusions: Anticoagulation 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.

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Feasibility of Anticoagulation Using Low Molecular‑Weight Heparin During Catheter-Directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

10.21203/rs.3.rs-42400/v3 ◽

2021 ◽

Author(s):

Yonghui Li ◽

Junwei Wang ◽

Rongzhou He ◽

Junmeng Zheng ◽

Zhibo Chen ◽

...

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Therapeutic Dose ◽

Infusion Rate ◽

Low Molecular Weight Heparin ◽

Anticoagulation Therapy ◽

Bleeding Complications ◽

Low Molecular Weight ◽

Catheter Directed Thrombolysis

Abstract Background: 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: The 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.Results: A 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) x 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) x 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. Conclusions: Anticoagulation 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.

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Markers of Hemostatic System Activation in Acute Deep Venous Thrombosis-Evolution during the First Days of Heparin Treatment

Thrombosis and Haemostasis ◽

10.1055/s-0038-1649698 ◽

1993 ◽

Vol 70 (06) ◽

pp. 0909-0914 ◽

Cited By ~ 45

Author(s):

Keyword(s):

Molecular Weight ◽

Venous Thrombosis ◽

Deep Venous Thrombosis ◽

Unfractionated Heparin ◽

Low Molecular Weight Heparin ◽

Factor Xa ◽

Low Molecular Weight ◽

Dose Adaptation ◽

Heparin Treatment ◽

Lung Scan

SummaryFibrin D-Dimer (D-Di), prothrombin activation fragment (F 1+2) and thrombin-antithrombin III complexes (TAT) were measured using ELISA procedures in the plasma of patients with an acute deep venous thrombosis (DVT), at presentation and on days 2, 6 and 10 after initiation of heparin treatment. Patients were randomly allocated into two treatment groups: 44 patients received adapted doses of continuous intravenous unfractionated heparin (UH) whereas 47 received 1 mg/kg every twelve hours of a low molecular weight heparin (enoxaparin) subcutaneously. A phlebography and a perfusion lung scan were performed before inclusion and on day 10. Failure of therapy (n = 9) was defined by venogram worsening or confirmed pulmonary embolism. Improvement (n = 44) or stationary state (n = 38) were defined by venogram evolution in the absence of new leg scan defects.At presentation, D-Di, F 1 + 2 and TAT were above cut-off values in 97, 66 and 89% of patients respectively. D-Di levels correlated with the extent of venous thrombosis whereas TAT and F 1 + 2 did not. Mean levels of D-Di decreased sharply during the first days of treatment but were still abnormal on day 10. A secondary increase of D-Di on days 6 or 10 by more than 3 μg/ml occurred in 4 of the 9 patients who developed a thromboembolic recurrence but in none of the 72 patients who had a more favorable outcome. F 1 + 2 and TAT time-courses were not related to clinical evolution. In the Enoxaparin group, there was no relationship between antifactor Xa activities and any biological markers. TAT and F 1 + 2 levels fell on day 2 and remained stable until day 10. In contrast, in the UH group, TAT and F 1 + 2 did not significantly decrease on day 2, probably due to a delay in dose adaptation, but they declined slowly until day 10.In conclusion, D-Di displays a higher sensitivity than F 1 + 2 or TAT for the diagnosis of D\T. D-Di, but not TAT or F 1 + 2, follow-up seems to be of potential value for early detection of recurrency. Hemostatic activation is controlled earlier by fixed doses of a low molecular weight heparin, irrespective of the plasma anti-factor Xa activities, than by unfractionated heparin at adapted doses.

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