Paolo Prandoni1, Walter Ageno2, Nicola Mumoli3, Nello Zanatta4, Davide Imberti5, Adriana Visonà6, Maurizio Ciammaichella7, Livio Simioni8, Roberto Cappelli9, Eugenio Bucherini10, Marcello Di Nisio11, Giampiero Avruscio12, Giuseppe Camporese12, Roberto Parisi13, Stefano Cuppini14, Giacomo Turatti15, Franco Noventa15, Lucia Sarolo15. 1. Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Italy. Electronic address: paoloprandoni@tin.it. 2. Department of Clinical Medicine, University of Insubria, Varese, Italy. 3. Department of Internal Medicine, Hospital of Livorno, Italy. 4. Division of General Medicine, Presidio Hospital of Conegliano, Italy. 5. Haemostasis and Thrombosis Center, Department of Internal Medicine, Hospital of Piacenza, Italy. 6. Department of Angiology, S. Giacomo Apostolo Hospital, Castelfranco Veneto, Italy. 7. Department of emergency, A.O. San Giovanni-Addolorata, Roma, Italy. 8. Department of Medicine, "S.Maria del Prato" Feltre Hospital, Ulss 1 Dolomiti Veneto, Italy. 9. Thrombosis Center, Hospital of Siena, Italy. 10. Department of Vascular Medicine, Hospital of Ravenna-Faenza, Italy. 11. Department of Medicine and Ageing Sciences, G. D'Annunzio University, Chieti, Italy. 12. Unit of Angiology, Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Italy. 13. Unit of Angiology, Internal Medicine, SS Giovanni e Paolo Hospital, Venice, Italy. 14. Department of Internal Medicine, Santa Maria della Misericordia Hospital, Rovigo, Italy. 15. Department of Cardiovascular Sciences, Vascular Medicine Unit, University of Padua, Italy.
Abstract
BACKGROUND: The recanalization rate in patients with deep venous thrombosis (DVT) of the legs treated with the direct oral anticoagulants (DOAC) is unknown. METHODS: In an Italian cohort, we investigated the rate of residual vein thrombosis (RVT) after three and/or six months in 352 patients with proximal DVT who had been treated with the DOACs as a stand-alone therapy or lead-in parenteral anticoagulants, and compared it to that recorded in a historical cohort of 1094 patients in which vitamin K antagonists (VKAs) had been employed. In both cohorts, RVT was defined as the ultrasound persistence of thrombotic material resulting in a diameter of at least 4mm of incompressibility of the proximal veins. RESULTS: RVT was detected in 143 patients treated with DOACs (41.2%) after three months and in 58 patients (21.1%) after six months; the corresponding figure in patients treated with conventional anticoagulation was 52.3% and 54.5%, respectively. After adjusting for the baseline characteristics, the odds ratio of RVT in patients treated with the DOACs as compared with those treated with conventional anticoagulation was 0.63 (95% CI, 0.48-0.81) after three months, and 0.17 (95% CI; 0.11-0.26) after six months. CONCLUSIONS: In patients with proximal DVT treated with the DOACs, the persistence of ultrasound detectable RVT is likely to occur less frequently than in patients treated with conventional anticoagulation. These results may have implications for the prognosis of patients with DVT.
BACKGROUND: The recanalization rate in patients with deep venous thrombosis (DVT) of the legs treated with the direct oral anticoagulants (DOAC) is unknown. METHODS: In an Italian cohort, we investigated the rate of residual vein thrombosis (RVT) after three and/or six months in 352 patients with proximal DVT who had been treated with the DOACs as a stand-alone therapy or lead-in parenteral anticoagulants, and compared it to that recorded in a historical cohort of 1094 patients in which vitamin K antagonists (VKAs) had been employed. In both cohorts, RVT was defined as the ultrasound persistence of thrombotic material resulting in a diameter of at least 4mm of incompressibility of the proximal veins. RESULTS: RVT was detected in 143 patients treated with DOACs (41.2%) after three months and in 58 patients (21.1%) after six months; the corresponding figure in patients treated with conventional anticoagulation was 52.3% and 54.5%, respectively. After adjusting for the baseline characteristics, the odds ratio of RVT in patients treated with the DOACs as compared with those treated with conventional anticoagulation was 0.63 (95% CI, 0.48-0.81) after three months, and 0.17 (95% CI; 0.11-0.26) after six months. CONCLUSIONS: In patients with proximal DVT treated with the DOACs, the persistence of ultrasound detectable RVT is likely to occur less frequently than in patients treated with conventional anticoagulation. These results may have implications for the prognosis of patients with DVT.
Authors: Elena Campello; Luca Spiezia; Chiara Simion; Daniela Tormene; Giuseppe Camporese; Fabio Dalla Valle; Anna Poretto; Cristiana Bulato; Sabrina Gavasso; Claudia Maria Radu; Paolo Simioni Journal: J Am Heart Assoc Date: 2020-11-23 Impact factor: 5.501
Authors: Pascale Notten; Jorinde H H van Laanen; Pieter Eijgenraam; Mark A F de Wolf; Ralph L M Kurstjens; Hugo Ten Cate; Arina J Ten Cate-Hoek Journal: Res Pract Thromb Haemost Date: 2020-04-08