Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece.
J Vasc Surg Venous Lymphat Disord. 2021 Nov;9(6):1568-1576.e1. doi: 10.1016/j.jvsv.2021.04.016. Epub 2021 May 6.
Direct oral anticoagulants (DOACs) have been recommended for the treatment of deep vein thrombosis (DVT). However, the benefits are uncertain for the prevention of post-thrombotic syndrome (PTS). We performed a systematic review and meta-analysis of reported studies to assess the efficacy of DOACs vs vitamin K antagonists for the risk reduction of PTS in patients with DVT.
We searched PubMed, Medline, the Cochrane Library, Embase, and the Web of Science for studies reporting on the development of PTS after acute DVT. The outcomes were the risk reduction of PTS, PTS severity, the presence of residual vein thrombosis, and the incidence of recurrent venous thromboembolic (VTE) events.
A total of 59,199 patients from six retrospective and two randomized controlled studies had received DOAC treatment and were followed up for the development of PTS. In all studies, rivaroxaban had been compared with initial low-molecular-weight heparin followed by warfarin. Of the 59,199 patients, 19,840 (33.5%) had received rivaroxaban and 39,377 (66.5%), warfarin. The rivaroxaban group had a significant reduction in PTS development compared with the warfarin group (odds ratio [OR], 0.52; 95% confidence interval [CI], 0.43-0.63; P < .001). Severe PTS was less common in the rivaroxaban group than in the warfarin group (3.7% vs 6.4%; OR, 0.55; 95% CI, 0.36-0.85; P = .024). Additionally, rivaroxaban was associated with a significant reduction in VTE recurrence (OR, 0.83; 95% CI, 0.59-1.18; P = .03) and low rates of residual vein thrombosis compared with warfarin (36.5% vs 51.8%; P = .037).
Rivaroxaban after acute DVT was associated with a reduced risk of PTS compared with warfarin. Patients treated with rivaroxaban more rarely developed severe PTS and recurrent VTE events compared with patients treated with warfarin.
直接口服抗凝剂（DOACs）已被推荐用于治疗深静脉血栓形成（DVT）。然而，对于预防血栓后综合征（PTS），其益处尚不确定。我们对已发表的研究进行了系统评价和荟萃分析，以评估 DOACs 与维生素 K 拮抗剂在预防 DVT 患者 PTS 风险方面的疗效。
我们检索了 PubMed、Medline、Cochrane 图书馆、Embase 和 Web of Science，以获取报告急性 DVT 后 PTS 发展情况的研究。结局指标为 PTS 风险降低、PTS 严重程度、残留静脉血栓形成以及复发性静脉血栓栓塞（VTE）事件发生率。
来自六项回顾性研究和两项随机对照研究的 59199 例患者接受了 DOAC 治疗，并随访 PTS 的发展情况。在所有研究中，均比较了利伐沙班与初始低分子肝素联合华法林的疗效。在 59199 例患者中，19840 例（33.5%）接受了利伐沙班治疗，39377 例（66.5%）接受了华法林治疗。与华法林组相比，利伐沙班组 PTS 发生率显著降低（比值比[OR]，0.52；95%置信区间[CI]，0.43-0.63；P<0.001）。利伐沙班组严重 PTS 发生率低于华法林组（3.7%比 6.4%；OR，0.55；95%CI，0.36-0.85；P=0.024）。此外，与华法林相比，利伐沙班与 VTE 复发风险显著降低相关（OR，0.83；95%CI，0.59-1.18；P=0.03），且残留静脉血栓形成发生率较低（36.5%比 51.8%；P=0.037）。
与华法林相比，急性 DVT 后应用利伐沙班可降低 PTS 风险。与华法林相比，接受利伐沙班治疗的患者发生严重 PTS 和复发性 VTE 事件的风险较低。
