Anticoagulant Therapies in Patients With Iliofemoral Deep Vein Thrombosis

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No differences were observed in patency rates or incidence of post-thrombotic syndrome in patients treated with rivaroxaban or a vitamin K antagonist.
No differences were observed in patency rates or incidence of post-thrombotic syndrome in patients treated with rivaroxaban or a vitamin K antagonist.

Rivaroxaban and vitamin K antagonists (VKAs) appear to have similar effectiveness and safety as anticoagulant therapeutic agents in patients being treated for acute iliofemoral deep vein thrombosis (IFDVT), according to a study published in Thrombosis Research.

The report was part of an ongoing prospective cohort study from the Swiss Venous Stent registry (ClinicalTrials.gov Identifier: NCT02433054). The investigators analyzed patients with acute IFDVT who underwent catheter-based early thrombus removal followed by venous stent placement. Patency rates and the incidence of post-thrombotic syndrome in patients treated with either rivaroxaban (73 patients) or a VKA (38 patients) were assessed using duplex ultrasound and Villalta scores.

The average patient follow-up duration was 24 months (range, 3-77). Anticoagulation therapy was time limited from 3 to 12 months in 47% of patients in the rivaroxaban group and 58% of patients in the VKA group (P =0.26). The rivaroxaban group had a shorter mean duration of therapy compared with the VKA group (180 ± 98 days vs 284 ± 199 days, P =0.01).

At 24 months, the overall primary and secondary patency rates were 82% (95% CI: 71-89) and 95% (95% CI: 87-98), respectively. No differences (P >.10 for both) were observed between the rivaroxaban group (87%, 95% CI: 76-94 and 95%, 95% CI: 85-98) and the VKA group (72%, 95% CI: 52-86 and 94%, 95% CI: 78-99). Overall, 86% of patients were free from post-thrombotic syndrome at the last follow-up. Again, no difference was observed between the rivaroxaban and VKA groups (85% vs 88%, P =0.76).

Only 2 patients experienced major bleeding events during the study; both events occurred in the peri-interventional period, and 1 occurred in each group.

The authors concluded that “rivaroxaban, started within 24 hours after the end of the endovascular procedure, appears to be at least as effective and safe as the combination [low molecular weight heparin]/VKA without an increase in bleeding complications.”

Reference

1. Sebastian T, Hakki LO, Spirk D, et al. Rivaroxaban or vitamin-K antagonists following early endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis [published online October 26, 2018]. Thromb Res. doi: 10.1016/j.thromres.2018.10.027

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