Clinical effects and safety of anticoagulation and endovascular therapy for acute deep venous thrombosis

Objective To investigate the clinical effects and safety of anticoagulation and endovascular therapy for acute iliac-femoral venous thrombosis (I-FVT). Methods A total of 142 patients who were definitely diagnosed with acute I-FVT were included from January 2015 to September 2016 in Xinjiang Uygur Autonomous Region People′s Hospital, including 40 cases undergoing anticoagulant therapy, (anticoagulation group) and 102 cases undergoing percutaneous endovascular therapy [endovascular therapy group; catheter directed thrombolysis (CDT), percutaneous mechanical thrombus removal (PMT), and PMT combined with CDT]. The cure rate, effective rate, and the degree of thrombus removal were compared between the two groups. The incidence of adverse events during treatment and the follow-up period was recorded. Results The cure rate (above knee: 58.8% vs 12.5%; below knee: 53.9% vs 10.0%), effective rate (above knee: 96.1% vs 65.0%; below knee: 97.1% vs 75.0%), and degree of thrombus removal differed significantly between the endovascular therapy group and anticoagulation group (P<0.001). During the 3-month follow-up period, there were 7 cases of puncture site hematoma, 13 cases of hematuria, 2 cases of secondary thrombosis of contralateral limbs, and 1 case of contrast-related nephropathy in endovascular therapy group. During the 6-, 12-, 24-month follow-up periods, the recurrence rate of deep venous thrombosis (7.8% vs 22.5%, 12.7% vs 27.5%, 18.4% vs 37.8%), the incidence of post-thrombotic syndrome (15.7% vs 37.5%, 20.6% vs 42.5%, 25.5% vs 54.1%), and Villalta score [(2.24±2.13) vs (5.15±2.93), (3.32±2.88) vs (6.90±4.07), (4.22±3.93) vs (8.11±4.85)] were significantly lower in the endovascular therapy group than in the anticoagulant therapy group (P<0.05). Conclusion Endovascular therapy for acute I-FVT has better efficacy than anticoagulation treatment alone, but endovascular therapy is invasive with more adverse events. Key words: Venous thrombosis; Anticoagulation therapy; Endovascular therapy