Department of vascular disease, University Medical Centre Ljubljana, Slovenia.
University of Texas, Health Science Center at Houston, Houston, TX, USA.
Thromb Res. 2017 Sep;157:46-48. doi: 10.1016/j.thromres.2017.05.029. Epub 2017 May 29.
Post-thrombotic syndrome (PTS) is a chronic complication of deep vein thrombosis (DVT) that affects 20% to 50% of DVT patients. Standard DVT treatment included vitamin K antagonists (usually warfarin) with low-molecular-weight heparin in the initial period. In recent years, direct oral anticoagulants (DOAC) were introduced. We aimed to investigate the influence of rivaroxaban and warfarin on PTS development.
Consecutive patients treated for DVT were included, 39 were treated with warfarin and 61 with rivaroxaban. We assessed symptoms and signs of PTS and calculated Villalta score 23months (median) after acute DVT diagnosis. Differences between patients treated with rivaroxaban and warfarin were investigated.
Patients in the rivaroxaban group had a lower prevalence of PTS than those treated with warfarin (25% vs. 49%, p=0.013). Logistic regression showed odds ratio of 2.9 (1.2-6.8, p=0.014) for PTS development in warfarin group compared to rivaroxaban group. When adjusted for other variables, the odds ratio was 3.5 (1.1-11.0, p=0.035).
Treatment of DVT with rivaroxaban might be associated with a lower risk for PTS development. A larger randomized trial would be needed for stronger evidence.
血栓后综合征（PTS）是深静脉血栓（DVT）的一种慢性并发症，影响 20%至 50%的 DVT 患者。标准的 DVT 治疗包括在初始阶段使用维生素 K 拮抗剂（通常是华法林）联合低分子肝素。近年来，直接口服抗凝剂（DOAC）被引入。我们旨在研究利伐沙班和华法林对 PTS 发展的影响。
连续纳入接受 DVT 治疗的患者，其中 39 例接受华法林治疗，61 例接受利伐沙班治疗。我们评估了 PTS 的症状和体征，并在急性 DVT 诊断后 23 个月（中位数）计算了 Villalta 评分。研究了接受利伐沙班和华法林治疗的患者之间的差异。
利伐沙班组患者 PTS 的发生率低于华法林组（25%比 49%，p=0.013）。Logistic 回归显示，与利伐沙班组相比，华法林组 PTS 发展的优势比为 2.9（1.2-6.8，p=0.014）。当调整其他变量时，比值比为 3.5（1.1-11.0，p=0.035）。
用利伐沙班治疗 DVT 可能与 PTS 发展的风险降低相关。需要更大规模的随机试验以提供更强有力的证据。
