Использование катетерного тромболизиса в дополнении к стандартной терапии ТГВ. Результаты наблюдения в пределах 6 месяцев.
J Thromb Haemost. 2009 Aug;7(8):1268-75. Epub 2009 Apr 30.
Catheter-directed thrombolysis vs. anticoagulant therapy alone in deep vein thrombosis: results of an open randomized, controlled trial reporting on short-term patency.Enden T, Kløw NE, Sandvik L, Slagsvold CE, Ghanima W, Hafsahl G, Holme PA, Holmen LO, Njaastad AM, Sandbaek G, Sandset PM; CaVenT study group.
Department of Hematology, Oslo University Hospital, Ullevål, Norway.
tone.enden@medisin.uio.noComment in: * J Thromb Haemost. 2009 Aug;7(8):1266-7.
Цитата:
Abstract
BACKGROUND: Approximately one in four patients with acute proximal deep vein thrombosis (DVT) given anticoagulation and compression therapy develop post-thrombotic syndrome (PTS). Accelerated removal of thrombus by thrombolytic agents may increase patency and prevent PTS.
OBJECTIVES: To assess short-term efficacy of additional catheter-directed thrombolysis (CDT) compared with standard treatment alone.
PATIENTS AND METHODS: Open, multicenter, randomized, controlled trial. Patients (18-75 years) with iliofemoral DVT and symptoms < 21 days were randomized to receive additional CDT or standard treatment alone. After 6 months, iliofemoral patency was investigated using duplex ultrasound and air-plethysmography assessed by an investigator blinded to previous treatment.
RESULTS: One hundred and three patients (64 men, mean age 52 years) were allocated additional CDT (n = 50) or standard treatment alone (n = 53). After CDT, grade III (complete) lysis was achieved in 24 and grade II (50%-90%) lysis in 20 patients. One patient suffered major bleeding and two had clinically relevant bleeding related to the CDT procedure. After 6 months, iliofemoral patency was found in 32 (64.0%) in the CDT group vs. 19 (35.8%) controls, corresponding to an absolute risk reduction (RR) of 28.2% (95% CI: 9.7%-46.7%; P = 0.004). Venous obstruction was found in 10 (20.0%) in the CDT group vs. 26 (49.1%) controls; absolute RR 29.1% (95% CI: 20.0%-38.0%; P = 0.004). Femoral venous insufficiency did not differ between the two groups.
CONCLUSIONS: After 6 months, additional CDT increased iliofemoral patency from 36% to 64%. The ongoing long-term follow-up of this study will document whether patency is related to improved functional outcome.
Вход
Регистрация
FAQ
Поиск
, extended treatment with conventional-intensity VKA was associated with a risk of major bleeding of approximately 1% per patient-year (low-intensity VKA is considered in Section 2.2). A metaanalysis of seven studies that compared durations of conventional-intensity anticoagulant therapy for VTE estimated the rate of major bleeding to be 1.1% per patient-year (18 episodes in 1,571 patient-years) during the extended phase of anticoagulation compared with 0.6% per patient-year (9 episodes during 1,497 patient-years) without anticoagulation (RR, 1.80; 95% CI, 0.72 to 4.51).