利伐沙班治疗上肢深静脉血栓形成：单中心经验及文献复习。
Rivaroxaban in the treatment of upper extremity deep vein thrombosis: A single-center experience and review of the literature.
机构信息
Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow 117997, Russian Federation; Clinical Hospital no.1 President's Administration of Russian Federation, 10 Starovolynskaya str., Moscow 121352, Russian Federation.
Pirogov Russian National Research Medical University, 1 Ostrovitianov str., Moscow 117997, Russian Federation.
出版信息
Thromb Res. 2019 Sep;181:24-28. doi: 10.1016/j.thromres.2019.07.008. Epub 2019 Jul 14.
INTRODUCTION
Direct oral anticoagulants (DOACs) have become widely used to treat patients with venous thromboembolism (VTE), but evidence about their use in the treatment of upper extremity deep vein thrombosis (UEDVT) is lacking.
OBJECTIVES
To assess rivaroxaban's efficacy and safety in the treatment of UEDVT.
PATIENTS/METHODS: This was a single-center prospective observational study involving patients with their first UEDVT episode confirmed by duplex ultrasound scan. All patients initially received low-molecular-weight heparin for 1 to 2 days and then were switched to rivaroxaban for 3-6 months. The primary endpoint was any symptomatic episode of recurrent VTE.
RESULTS
Thirty patients were included in the study, and all patients were followed for 6 months. There were no episodes of recurrent symptomatic venous thromboembolism or asymptomatic UEDVT. No episode of major bleeding was observed. Clinically relevant non-major bleeding occurred in two patients (6.7%, 95% confidence interval [CI]: 1.9-21.4%) with uterine bleeding and large skin hemorrhage. Minor bleeding was observed in two patients (6.7%, 95% CI: 1.9-21.4%) presenting with nasal and gingival bleeding. Recanalization of the upper extremity deep veins was observed in all affected limbs at three months, and it persisted up to 6 months. The signs of upper limb post-thrombotic syndrome (PTS) were found in four patients (13.4%; 95% CI: 5.4-29.8%), and the mean modified Villalta score was 2.1 ± 1.9.
CONCLUSION
Treatment of UEDVT with rivaroxaban, preceded by one to two days of LMWH, seems to be safe and effective.
简介
直接口服抗凝剂（DOACs）已广泛用于治疗静脉血栓栓塞症（VTE）患者，但关于其在治疗上肢深静脉血栓形成（UEDVT）中的应用证据尚缺乏。
目的
评估利伐沙班治疗 UEDVT 的疗效和安全性。
患者/方法：这是一项单中心前瞻性观察性研究，纳入了经双功超声扫描证实首次发生 UEDVT 的患者。所有患者最初接受低分子肝素治疗 1-2 天，然后换用利伐沙班治疗 3-6 个月。主要终点是任何有症状的复发性静脉血栓栓塞事件。
结果
研究纳入 30 例患者，所有患者均随访 6 个月。无复发性有症状静脉血栓栓塞或无症状 UEDVT 发作。未观察到大出血事件。两名患者（6.7%，95%置信区间 [CI]：1.9-21.4%）出现子宫出血和大皮肤出血，发生了临床相关非大出血事件。两名患者（6.7%，95% CI：1.9-21.4%）出现鼻和牙龈出血，发生了轻微出血事件。所有受累肢体的上肢深静脉在三个月时均观察到再通，且持续至 6 个月。4 例患者（13.4%，95% CI：5.4-29.8%）出现上肢血栓后综合征（PTS）体征，平均改良 Villalta 评分 2.1±1.9。
结论
在接受 LMWH 治疗 1-2 天后，使用利伐沙班治疗 UEDVT 似乎安全且有效。
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