Department of Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
UOC Angiologia, Azienda ULSS 2 Marca Trevigiana, Ospedale San Giacomo, Castelfranco Veneto, Italy.
J Thromb Thrombolysis. 2020 Aug;50(2):355-360. doi: 10.1007/s11239-020-02044-4.
Upper-extremity deep vein thrombosis (UEDVT) accounts for about 5-10% of all cases of deep vein thrombosis (DVT). It is often associated with cancer and/or presence of a central venous catheter (CVC), but it may also occur in the absence of these favoring conditions. The safety and efficacy of using direct oral anticoagulants (DOACs) in subjects with UEDVT has not been systematically evaluated and the only data available in the literature derive from anecdotal evidence, analysis of registries, and small single-centre studies. In addition, a specific analysis of UEDVT not associated with cancer and/or CVC has never been made. In this study, we specifically focused on patients with no cancer and without a CVC who were diagnosed with a first episode of UEDVT and were treated with a DOAC. We studied 61 patients, treated in six Italian centres between January 2014 and December 2018. Treatment lasted at least 3 months in all patients. In terms of efficacy, no recurrence of thrombosis or pulmonary embolism were recorded, while Doppler ultrasonography, performed after at least three months of treatment, documented in all cases either partial or complete recanalization of obstructed veins. In terms of safety, no cases of major bleedings were recorded. This is the only series available in the literature of patients treated with DOACs for UEDVT not associated with cancer and/or CVC. This small multicenter real world experience supports the concept that DOACs might be safe and effective for treating UEDTV. Further studies are required to better understand the role of DOACs in these patients.
上肢深静脉血栓形成（UEDVT）约占所有深静脉血栓形成（DVT）病例的 5-10%。它通常与癌症和/或中央静脉导管（CVC）的存在有关，但也可能在没有这些有利条件的情况下发生。在患有 UEDVT 的患者中使用直接口服抗凝剂（DOAC）的安全性和疗效尚未得到系统评估，并且文献中唯一可用的数据来自轶事证据、登记分析和小型单中心研究。此外，从未对与癌症和/或 CVC 无关的 UEDVT 进行过专门分析。在这项研究中，我们专门关注了没有癌症且没有 CVC 的首次 UEDVT 患者，并使用 DOAC 进行了治疗。我们研究了 61 名患者，他们在 2014 年 1 月至 2018 年 12 月期间在意大利的六个中心接受治疗。所有患者的治疗至少持续 3 个月。在疗效方面，没有记录到血栓或肺栓塞的复发，而在至少治疗三个月后进行的多普勒超声检查显示，所有病例的阻塞静脉均部分或完全再通。在安全性方面，没有记录到重大出血事件。这是文献中唯一一组用 DOAC 治疗与癌症和/或 CVC 无关的 UEDVT 患者的系列研究。这项小型多中心真实世界的经验支持了 DOAC 可能对治疗 UEDTV 安全有效的观点。需要进一步研究以更好地了解 DOAC 在这些患者中的作用。
