Cor Vasa 2022, 64(6):601-610 | DOI: 10.33678/cor.2022.088

Pharmaco-Mechanical Thrombectomy vs. Conventional Anticoagulant Management of Acute Lower Extremity Deep Vein Thrombosis - Long-Term Outcomes

Orhan Rodoplu^a, Ibrahim Erdinc^b, Cuneyd Ozturk^c

^a Atasehir Florence Nightingale Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey

^b Izmir Bozyaka Training end Research Hospital, Cardiovascular Surgery Clinic, Izmir, Turkey

^c Kadikoy Florence Nightingale Hospital, Cardiovascular Surgery Clinic, Istanbul, Turkey

Objective: In this study, we aimed to evaluate the long-term effects of pharmaco-mechanical thrombectomy and compare its efficiency and safety against anticoagulation together with the use of compression stockings in patients with proximal deep vein thrombosis of the lower extremity.

Methods: A total of 228 patients, between January 2013 and January 2020, who presented to the clinic with acute deep vein thrombosis of the lower extremity were investigated retrospectively. There were 112 pa- tients in the anticoagulation following pharmacomechanical thrombectomy group (Group 1) and 116 patients in the conventional anticoagulation with compression stockings group (Group 2).

Results: There was no significant difference in the post-thrombotic syndrome occurrence assessed with Villalta Scores at 6-month follow-up. However; at 12-, 24- and 36-month follow-up, the incidence of the post-thrombotic syndrome was lower in the Group 1 compared to Group 2 (21.4%, 30.3%, 36.6% vs. 33.6%, 53.4%, 61.2%). Insufficient recanalization was present in 41 of 112 patients at 36 months in the Group 1, and in 71 of 116 patients in Group 2 at 36 months; correlating to an absolute risk reduction of 25.6% (95% CI 9.2-37.5; p = 0.001). The recurrent thrombosis rates in the Group 2 were significantly higher than Group 1 (18.9% vs 7.1%; p = 0.002) in the 6- to 36-month follow-up.

Conclusion: The results of our study demonstrated that pharmacomechanical thrombectomy is a safe and effective treatment modality in case of lower extremity acute deep vein thrombosis. It has been associated with reduced post-thrombotic syndrome and recurrent venous thrombosis rates in the long-term follow-up when compared with the anticoagulation and compression stockings.

Keywords: Anticoagulant therapy, Deep vein thrombosis (DVT), Pharmaco-mechanical therapy (PMT), Post-thrombotic syndrome (PTS),

Received: June 1, 2022; Revised: July 22, 2022; Accepted: July 27, 2022; Published: December 15, 2022  Show citation