Ilya Schastlivtsev1, Kirill Lobastov2, Sergey Tsaplin3, Irina Kanzafarova2, Victor Barinov3, Leonid Laberko2, Grigory Rodoman2, Sergey Zhuravlev4. 1. Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow 117997, Russian Federation; Clinical Hospital no.1 President's Administration of Russian Federation, 10 Starovolynskaya str., Moscow 121352, Russian Federation. Electronic address: science@phlebosurgery.ru. 2. Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow 117997, Russian Federation. 3. Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow 117997, Russian Federation; Clinical Hospital no.1 President's Administration of Russian Federation, 10 Starovolynskaya str., Moscow 121352, Russian Federation. 4. Clinical Hospital no.1 President's Administration of Russian Federation, 10 Starovolynskaya str., Moscow 121352, Russian Federation.
Abstract
INTRODUCTION: Direct oral anticoagulants (DOACs) have become widely used to treat patients with venous thromboembolism (VTE), but evidence about their use in the treatment of upper extremity deep vein thrombosis (UEDVT) is lacking. OBJECTIVES: To assess rivaroxaban's efficacy and safety in the treatment of UEDVT. PATIENTS/ METHODS: This was a single-center prospective observational study involving patients with their first UEDVT episode confirmed by duplex ultrasound scan. All patients initially received low-molecular-weight heparin for 1 to 2 days and then were switched to rivaroxaban for 3-6 months. The primary endpoint was any symptomatic episode of recurrent VTE. RESULTS: Thirty patients were included in the study, and all patients were followed for 6 months. There were no episodes of recurrent symptomatic venous thromboembolism or asymptomatic UEDVT. No episode of major bleeding was observed. Clinically relevant non-major bleeding occurred in two patients (6.7%, 95% confidence interval [CI]: 1.9-21.4%) with uterine bleeding and large skin hemorrhage. Minor bleeding was observed in two patients (6.7%, 95% CI: 1.9-21.4%) presenting with nasal and gingival bleeding. Recanalization of the upper extremity deep veins was observed in all affected limbs at three months, and it persisted up to 6 months. The signs of upper limb post-thrombotic syndrome (PTS) were found in four patients (13.4%; 95% CI: 5.4-29.8%), and the mean modified Villalta score was 2.1 ± 1.9. CONCLUSION: Treatment of UEDVT with rivaroxaban, preceded by one to two days of LMWH, seems to be safe and effective.
INTRODUCTION: Direct oral anticoagulants (DOACs) have become widely used to treat patients with venous thromboembolism (VTE), but evidence about their use in the treatment of upper extremity deep vein thrombosis (UEDVT) is lacking. OBJECTIVES: To assess rivaroxaban's efficacy and safety in the treatment of UEDVT. PATIENTS/ METHODS: This was a single-center prospective observational study involving patients with their first UEDVT episode confirmed by duplex ultrasound scan. All patients initially received low-molecular-weight heparin for 1 to 2 days and then were switched to rivaroxaban for 3-6 months. The primary endpoint was any symptomatic episode of recurrent VTE. RESULTS: Thirty patients were included in the study, and all patients were followed for 6 months. There were no episodes of recurrent symptomatic venous thromboembolism or asymptomatic UEDVT. No episode of major bleeding was observed. Clinically relevant non-major bleeding occurred in two patients (6.7%, 95% confidence interval [CI]: 1.9-21.4%) with uterine bleeding and large skin hemorrhage. Minor bleeding was observed in two patients (6.7%, 95% CI: 1.9-21.4%) presenting with nasal and gingival bleeding. Recanalization of the upper extremity deep veins was observed in all affected limbs at three months, and it persisted up to 6 months. The signs of upper limb post-thrombotic syndrome (PTS) were found in four patients (13.4%; 95% CI: 5.4-29.8%), and the mean modified Villalta score was 2.1 ± 1.9. CONCLUSION: Treatment of UEDVT with rivaroxaban, preceded by one to two days of LMWH, seems to be safe and effective.
Authors: Angelo Porfidia; Giulia Cammà; Nicola Coletta; Margherita Bigossi; Igor Giarretta; Andrea Lupascu; Giuseppe Scaletta; Enrica Porceddu; Paolo Tondi; Giovanni Scambia; Gabriella Ferrandina; Roberto Pola Journal: Front Cardiovasc Med Date: 2022-06-28