scholarly journals Treatment of Acute Iliofemoral Deep Vein Thrombosis; Does Catheter Directed Thrombolytic Therapy Change Outcomes?

2019 ◽  
Vol 4 (3) ◽  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Iliac Vein ◽  
P Value ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Group A ◽  
Deep Vein

Background: Iliofemoral deep vein thrombosis (DVT) is associated with severe post-thrombotic morbidity when treated with anticoagulation alone. Catheter- directed thrombolysis (CDT) allows early removal of thrombus and reduces valvular reflux and Post-thrombotic Syndrome (PTS). Patients and methods: This prospective randomized multi-center controlled two- arm blind study was conducted in 6 centers on 252 patients with iliofemoral DVT. Patients were randomly allocated by using simple random allocation cards method into two groups; Group (A): CDT followed by oral anticoagulation (N=126 (50%)), Group (B): Standard DVT therapy (N=126 (50%)). Follow-up was for 24 months. Results: Patients of group (A) significantly complained less pain at 10 & 30 days (P-Value: 0.02 & 0.04 respectively). Also there was significant decrease in leg circumference in group (A) at 10 & 30 days (P-Value: 0.001 & 0.03 respectively). Patency of iliac vein segment was significantly higher in group (A) during the 24 months follow up (P-Value <0.001 (HS)). Patients in group (A) developed less PTS at six months, at one year and at two years (P-Value: 0.024, 0.017 and 0.035 respectively). Better Quality of life was observed in group (A) (P-Value: 0.003). Conclusion: Addition of catheter-directed thrombolysis in the treatment of acute iliofemoral DVT; was safe and tolerated by most of the patients with better effect to reduce leg pain & circumference. It was considered a protecting weapon to prevent post-thrombotic syndrome and so improve quality of life and was related to achievement of higher iliac vein patency and less reflux.

Patency rate and quality of life after ultrasound-accelerated catheter-directed thrombolysis for deep vein thrombosis

2017 ◽  
Vol 33 (4) ◽  
pp. 251-260 ◽  
Author(s):  
Alexander Gombert ◽  
Ricarda Gombert ◽  
Mohammad E. Barbati ◽  
Philipp Bruners ◽  
Andras Keszei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Patency Rate ◽  
Postthrombotic Syndrome ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Good Patency ◽  
Deep Vein

Purpose Studies on ultrasound-accelerated, catheter-directed thrombolysis of acute deep vein thrombosis emphasize good patency rates and low complication rates. Therefore, we analyzed quality of life besides technical success and patency in our patients after ultrasound-accelerated, catheter-directed thrombolysis. Methods Between 2009 and 2014, 42 patients suffering from iliofemoral deep vein thrombosis received ultrasound-accelerated, catheter-directed thrombolysis. Follow-up included clinical exanimation and ultrasound. Thirty patients (36 interventions), mean age 41.3 years (range 19–71 years), 56.6% women (17/30), completed the surveys. Five different scores were used to assess the quality of life and symptoms of postthrombotic syndrome: SF36, Euro-QOL 5D, PDI, VEINES-QOL/Sym, and the Villalta score. Results Mean therapy duration of ultrasound-accelerated, catheter-directed thrombolysis was 76.4 h and therapeutic success could be reported in 80.5% (29/36). Successful ultrasound-accelerated, catheter-directed thrombolysis was followed by stent angioplasty in 58.3% (21/36) procedures. Overall complication rate was 19.44%, mainly formed by minor bleedings. Mean follow-up was 38.5 months. The primary patency rate was 63.8%, the assisted-primary and the secondary patency rate were 80.5%. We observed an improved quality of life in our patients’ cohort compared to patients suffering from postthrombotic syndrome. Conclusion Although ultrasound-accelerated, catheter-directed thrombolysis is feasible with good patency rates, further prospective randomized trials are necessary to evaluate the value of thrombus removal in iliofemoral deep vein thrombosis in comparison to conservative treatment.

Iliac vein stenting as a durable option for residual stenosis after catheter-directed thrombolysis and angioplasty of iliofemoral deep vein thrombosis secondary to May–Thurner syndrome

2013 ◽  
Vol 29 (7) ◽  
pp. 461-470 ◽  
Author(s):  
Jae Young Park ◽  
Jong Hyuk Ahn ◽  
Yong Sun Jeon ◽  
Soon Gu Cho ◽  
Jang Yong Kim ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Patency Rate ◽  
Iliac Vein ◽  
Primary Patency ◽  
Primary Patency Rate ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Acute Deep Vein Thrombosis ◽  
Deep Vein

Introduction This study aims to evaluate the primary patency and clinical outcomes after stenting for residual iliac venous stenosis during catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis arising from May–Thurner syndome. Methods A retrospective study was done for the all patients who underwent iliac vein stenting after catheter-directed thrombolysis treatment of acute iliofemoral deep vein thrombosis due to May–Thurner syndrome from January 2005 to April 2011 in Inha University Hospital. Patient information was assembled from the electronic medical records, imaging and interview. The patency of iliac vein stent was evaluated with serial computed tomography. Results Fifty-one patients were enrolled. The median age was 70 years (range 44–86). There were 37 females (72.5%). The duration of symptoms of acute deep vein thrombosis before catheter-directed thrombolysis treatment was 6 days (median, range 1–33). Self-expanding stent was used for iliac vein stenting. Initial technical success rate was 94.1%. There were two complications (3.9%): an arteriovenous fistula formation in left popliteal area and a right inguinal hematoma. Mean follow-up was 15.6 months (range 6 days–80.8 months). Primary patency rate after iliac vein stenting was 95.8% at 6 months, 87.5% at 12 months and 84.3% at 24 months. Four patients had recurrent thrombotic occlusion (7.8%) during the follow-up. Conclusion Iliac vein stenting showed good primary patency rate with few complications. Iliac vein stenting is a durable option for residual stenosis after catheter-directed thrombolysis treatment of acute deep vein thrombosis in May–Thurner syndrome.

scholarly journals Quality of Life in Patients With Cancer Under Prolonged Anticoagulation for High-Risk Deep Vein Thrombosis: a Long-Term Follow-Up

2020 ◽  
Vol 26 ◽  
pp. 107602962091829 ◽  
Author(s):  
Mariasanta Napolitano ◽  
Maria Francesca Mansueto ◽  
Simona Raso ◽  
Sergio Siragusa
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Anticoagulant Treatment ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
Long Term Follow Up ◽  
Deep Vein

Current guidelines recommend to prolong anticoagulant treatment in patients with cancer with venous thromboembolism (VTE); only few studies evaluated other parameters than cancer itself for selecting patients at higher risk of recurrent VTE. Long-term management of VTE is thus challenged by several controversies mainly for patients compliance. We here report results of a long-term follow-up in patients with deep vein thrombosis under anticoagulant treatment with low-molecular-weight heparin (LMWH) for residual vein thrombosis (RVT) detected at compression ultrasonography (CUS), 6 months after standard anticoagulant treatment. Patients with RVT were deemed at high risk of recurrences and included in the current observational study. They continued LMWH (reduced at 75% standard dose) for further additional 2 years after enrolment or until death. Patients were followed up every 3 months or earlier, if needed. Among ancillary study end points, there was the assessment of patients’ quality of life during daily treatment with subcutaneous injections. Quality of life was determined by the EORTC-C30 questionnaire, administered by a skilled psychologist at enrolment and every 6 months follow-up visits. Overall, 128 patients were evaluated during follow-up. Mean global EORTC-C30 score at enrollment and at 6, 12 and 24 months follow-up were 52.1, 51.4, 50.8 and 50.1, respectively. There were no statistically significant differences between scores at enrolment and at the last available follow-up (P = .1). Long-term treatment with LMWH resulted, effective and safe, it was globally well tolerated and exempt of negative impact on quality of life of the enrolled patients. Reported results support long-term anticoagulant treatment with LMWH in cancer patients at risk of recurrent VTE.

scholarly journals Quality of life after catheter-directed thrombolysis and standard anticoagulation for iliofemoral deep-vein thrombosis

2019 ◽  
Vol 6 (4) ◽  
pp. 274
Author(s):  
MK Ayyappan ◽  
JithinJagan Sebastian ◽  
Pranay Pawar ◽  
Kapil Mathur ◽  
Radhakrishnan Raju ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Deep Vein Thrombosis ◽  
Vein Thrombosis ◽  
Catheter Directed Thrombolysis ◽  
Deep Vein

Residual Vein Thrombosis for Assessing the Optimal Management of Deep Vein Thrombosis in Cancer Patients: An Interim Analysis of the Cancer DACUS Study.

Blood ◽  
2008 ◽  
Vol 112 (11) ◽  
pp. 985-985 ◽  
Author(s):  
Sergio Siragusa
Keyword(s):  
Deep Vein Thrombosis ◽  
Cancer Patients ◽  
Major Bleeding ◽  
Recurrent Events ◽  
P Value ◽  
Vein Thrombosis ◽  
Group A ◽  
Group B ◽  
Deep Vein

Type and duration of anticoagulation is still matter of debate in cancer patients with acute Deep Vein Thrombosis (DVT) of the lower limbs. Residual Vein Thrombosis (RVT) has been proven to be effective for assessing the optimal duration of oral anticoagulants in non cancer patients (Siragusa S et al Blood2008:112:511-5). In the present study we evaluate the role of a RVT-based management of anticoagulation with Low-Molecular Weight Heparin in cancer patients with acute DVT. Materials and Methods. Cancer patients with a first episode of DVT were treated with LMWH at therapeutic dosage for 1 month followed by dose reduction of 25% in the next 5 months. At this time, they were managed according to RVT findings: those with RVT were randomized to continue anticoagulants for 6 additional months (Group A1) or to stop (Group A2), while patients without RVT stopped LMWH (Group B). Outcomes were recurrent venous thromboembolism and/or major bleeding. Results. Over a period of 18 months, 134 patients were evaluated across 12 centers in Italy; clinical characteristics and duration of follow-up are reported in the Table 1. RVT was detected in 92 (68.6%) patients; recurrent events occurred in 23.4% of those who discontinued and 15.5% of those who continued LMWH (Table 2 and Figure 1). The adjusted Hazard Ratio (HR) for age and sex (Group A2 vs A1) was 1.58 (95% confidence interval [CI], 0.85–2.93; P = .145). Of the 42 (31.3%) patients without RVT, one had a recurrence (2.3%) (Table 2 and Figure 1). The adjusted HR (B vs A1) was 4.54 (CI 2.3–6.66; P =.028). One major bleeding event occurred in each group of patients who stopped (Group A2 and B) and 2 in those who continued anticoagulation (Table 2). Overall, 31 (23.1%) patients died due to cancer progression after a median follow-up of 13.2 months after randomization. Conclusions. The Cancer DACUS is the first study evaluating an individual marker for assessing duration of anticoagulation in active cancer population. This interim analysis shows that absence of RVT identifies a group of patients at low risk for recurrent thrombosis who can safely stop LMWH after 6 months. Figure 1. Kaplan-Meyer curve for recurrent events among groups Figure 1. Kaplan-Meyer curve for recurrent events among groups Table 1. Baseline patients characteristics Group A 1 (n.45) Group A 2 (n.47) Group B (n.42) P value* *P value refers to chi-squared test unless specified. ^Time from randomization (6 months after the index Deep Vein Thrombosis) #Active cancer at the time of diagnosis Female sex (%) 22 (48.8) 23 (48.9) 20 (47.6) 0.999 Age, mean + SD (y) 58.2 ± 12.2 63.7 ± 11.1 57.8 ± 11.6 0.124 Total duration of follow-up, (y)^ 31.5 32.8 29.9 0.146 Mean follow-up, (y)^ 1.2 ± 0.56 1.1 ± 0.53 1.1 ± 0.60 0.156 #Type of cancer: Gastrointestinal, n (%) 16 (35.5) 18 (38.3) 16 (38) 0.32 Genitourinary, n (%) 9 (20) 7 8 (17) 7 (16.6) 0.23 Breast, n (%) (15.5) 8 6 (12.7) 6 (14.2) 0.45 Lung, n (%) (17.7) 5 10 (21.2) 10 (23.8) 0.32 Haematologic, n (%) (11.1) 5 (10.6) 6 (14.2) 0.67 Table 2. Study Outcomes Outcomes Group A 1 (n.45) Group A 2 (n.47) Group B (n.42) P value* * P value refers to chi-squared test unless specified. ** P value refers to Fisher exact test 0.021 0.030 A1 vs B** Recurrences, n/total (%) 7/45 (15.5) 11/47(23.4) 1/42 (2.3) 0.010 A2 vs B** 0.733 A1 vs A2** Recurrences, n/100 person-year (%) 7/34.75 (20.1) 11/40.33 (27.3) 1/38.92 (2.5) 0.008 Type of recurrent VTE DVT 5 8 1 DVT + PE 2 2 0 Isolated PE 0 1 0 Subtype Controlateral 1 2 1 Major bleeding, n/total (%) 2/45 (4.4) 1/47(2.1) 1/42(2.3) 0.054** Major bleeding n/100 person-yr(%) 2/40.17 (4.9) 1/46.83 (2.1) 1/36.75 (2.7) 0.390

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