Arianna Foundation on Anticoagulation, Via P. Fabbri 1/3, 40138, Bologna, Italy.
Department of Clinical Medicine, University of Insubria, Varese, Italy.
Intern Emerg Med. 2020 Apr;15(3):447-452. doi: 10.1007/s11739-019-02215-z. Epub 2019 Oct 30.
The novel direct oral anticoagulants (DOAC) have been shown to be at least as effective as and safer than conventional anticoagulants for the initial and long-term treatment of venous thromboembolic disorders. However, the rate of post-thrombotic syndrome (PTS) in patients with deep-vein thrombosis (DVT) treated with the DOACs is unknown. With the adoption of the Villalta scale, we assessed the rate of PTS at the end of the follow-up period in a consecutive series of 309 outpatients with acute proximal DVT who had received at least 3 months of treatment with a DOAC and had been followed-up for up to 3 years. The rate of PTS development was compared with that recorded in a historical cohort of 1036 consecutive patients who had been treated with vitamin K antagonists (VKA) and had received a similar follow-up examination. Logistic regression analysis, including propensity scoring to adjust for differing probabilities of undergoing VKA/DOAC, was used to identify predictors of PTS. PTS developed in 87 patients (28.2%) treated with the DOACs (severe in 12), and in 443 patients (42.8%) treated with VKAs (severe in 61). After adjusting for estimated propensity score, age, gender, concomitant symptoms of pulmonary embolism, duration of anticoagulation and development of residual vein thrombosis, the risk of PTS in the DOAC-treated patients was reduced by 54% in comparison to patients treated with conventional anticoagulation (odds ratio 0.46; 95% CI 0.33 to 0.63). We conclude that in comparison to VKAs, the use of the direct oral anticoagulants has the potential to offer a more favorable prognosis in terms of PTS development.
新型直接口服抗凝剂（DOAC）在初始和长期治疗静脉血栓栓塞性疾病方面至少与传统抗凝剂同样有效且更安全。然而，接受 DOAC 治疗的深静脉血栓（DVT）患者发生血栓后综合征（PTS）的比率尚不清楚。采用 Villalta 量表，我们评估了 309 例接受 DOAC 治疗至少 3 个月且随访时间长达 3 年的急性近端 DVT 门诊患者在随访期末 PTS 的发生率，并与接受维生素 K 拮抗剂（VKA）治疗且接受相似随访检查的 1036 例连续患者的记录率进行了比较。使用逻辑回归分析，包括倾向评分以调整 VKA/DOAC 治疗的概率差异，确定 PTS 的预测因素。87 例（28.2%）接受 DOAC 治疗的患者（严重 PTS12 例）和 443 例（42.8%）接受 VKA 治疗的患者（严重 PTS61 例）发生 PTS。在校正估计的倾向评分、年龄、性别、肺栓塞并存症状、抗凝时间和残留静脉血栓形成后，与接受传统抗凝治疗的患者相比，接受 DOAC 治疗的患者 PTS 的风险降低了 54%（比值比 0.46；95%CI 0.33 至 0.63）。我们的结论是，与 VKA 相比，直接口服抗凝剂的使用在 PTS 发展方面具有更有利的预后潜力。
