Department of Medicine and Surgery, University of Insubria, Varese, Italy.
National Hemophilia Center, Institute of Thrombosis and Hemostasis, Sheba Medical Center, Tel-Hashomer, Israel.
J Thromb Haemost. 2022 Feb;20(2):366-374. doi: 10.1111/jth.15574. Epub 2021 Nov 8.
Inferior vena cava (IVC) thrombosis is a rare form of venous thromboembolism (VTE). The optimal treatment strategies and outcomes are unclear in patients with this presentation.
We aimed to compare baseline characteristics, treatment patterns and 24-month outcomes in IVC thrombosis patients (n = 100) with lower extremity deep vein thrombosis (LEDVT) patients (n = 7629).
GARFIELD-VTE is a prospective, observational registry of 10 868 patients with objectively diagnosed VTE from 415 sites in 28 countries.
IVC thrombosis patients were younger (51.9 vs. 59.8 years), more frequently had active cancer (26.0% vs. 8.9%) or history of cancer (21.0% vs. 12.2%), and less frequently had recent trauma or surgery than LEDVT patients. IVC thrombosis was more frequently treated with parenteral anticoagulants alone (35.1% vs. 15.9%), whereas patients with LEDVT more commonly received vitamin K antagonists (32.0% vs. 25.8%) or direct oral anticoagulants (49.0% vs. 35.1%). Thrombolysis (11.0% vs. 3.6%) and surgical/mechanical interventions (4.0% vs. 1.4%) were more frequent in IVC thrombosis. At 24-months, the rate per 100 person-years (95% confidence interval) of all-cause mortality was higher in patients with IVC thrombosis than LEDVT (13.28 [8.57-20.58] vs. 4.91 [4.55-5.3]); the incidence of cancer-associated mortality was comparable as was the incidence of VTE recurrence (4.11 [1.85-9.15] vs. 4.18 [3.84-4.55]). Major bleeding was slightly higher in IVC thrombosis (2.03 [0.66-6.31] vs. 1.66 [1.45-1.89]).
In summary, IVC thrombosis patients have higher all-cause mortality rates than those with LEDVT, a finding only partly attributable to malignancy.
下腔静脉（IVC）血栓形成是一种罕见的静脉血栓栓塞症（VTE）。目前尚不清楚此类患者的最佳治疗策略和结局。
我们旨在比较 100 例 IVC 血栓形成患者（n=100）和下肢深静脉血栓形成（LEDVT）患者（n=7629）的基线特征、治疗模式和 24 个月的结局。
GARFIELD-VTE 是一项前瞻性、观察性登记研究，纳入了来自 28 个国家的 415 个研究中心的 10868 例经客观诊断的 VTE 患者。
IVC 血栓形成患者较年轻（51.9 岁 vs. 59.8 岁），更常患有活动性癌症（26.0% vs. 8.9%）或癌症史（21.0% vs. 12.2%），且近期创伤或手术史较少。IVC 血栓形成更常单独接受静脉内抗凝治疗（35.1% vs. 15.9%），而 LEDVT 患者更常接受维生素 K 拮抗剂（32.0% vs. 25.8%）或直接口服抗凝剂（49.0% vs. 35.1%）。IVC 血栓形成患者溶栓（11.0% vs. 3.6%）和手术/机械介入（4.0% vs. 1.4%）更为常见。24 个月时，IVC 血栓形成患者全因死亡率（每 100 人年率[95%置信区间]）高于 LEDVT 患者（13.28[8.57-20.58] vs. 4.91[4.55-5.3]）；癌症相关性死亡率相当，VTE 复发率也相当（4.11[1.85-9.15] vs. 4.18[3.84-4.55]）。IVC 血栓形成患者大出血发生率略高（2.03[0.66-6.31] vs. 1.66[1.45-1.89]）。
总之，IVC 血栓形成患者的全因死亡率高于 LEDVT 患者，这一发现部分归因于恶性肿瘤。
