Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, People's Republic of China.
J Thromb Thrombolysis. 2023 Feb;55(2):365-375. doi: 10.1007/s11239-023-02770-5. Epub 2023 Jan 11.
The therapeutic regimen option for the cancer-associated thrombosis (CAT) patients is still a major clinical challenge. The present study aimed to investigate the safety and efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) with AngioJet treatment compared with the conventional anticoagulation alone therapy in the patients with CAT. We retrospectively reviewed the patients who underwent PCDT and/or anticoagulation for the treatment of CAT between August 1, 2016 and March 1, 2022. Each patient was divided into the PCDT group or the anticoagulation alone group. The baseline demographics, comorbidities, clinical characteristics, treatment details, course data were reviewed. A total of 51 eligible patients were included, of whom 21 were in PCDT group (mean age, 60.1 ± 13.0 years; 52.4% male) and 30 in anticoagulation alone group (mean age, 66.6 ± 11.1 years; 50.0% male). No significant differences regarding age, sex, onset time, limb characteristics, cancer conditions or risk factors were detected (p > .05). After PCDT, grade III lysis was achieved in 8 and grade II lysis in 11 patients. Clinical success was achieved in 90.5% (19/21) patients. The symptoms of leg pain and swelling were significantly improved in both groups. Except for transient macroscopic hemoglobinuria occurring in PCDT group, none of all patients suffered from procedure-related and major complications. Minor complications such as bleeding events occurred in 23.8% (5/21) of patients in PCDT group compared with 10.0% (3/30) in anticoagulation alone group (p > .05). At the 6-month follow-up, iliofemoral patency was found an absolute risk reduction of 37.9% (70.0 vs. 32.1%) (95% CI: 1.183-4.008%; P = 0.010). The incidence of mild PTS was 5.0% (1/20) in PCDT group compared with 10.7% (3/28) in anticoagulation alone group (p > .05). The PCDT is a safe and effective modality in managing patients with CAT, leading to improved clinical outcomes with a low complication. The PCDT was more effective than anticoagulation alone in massive symptom relief and venous patency.
癌症相关血栓形成（CAT）患者的治疗方案仍然是一个主要的临床挑战。本研究旨在探讨 AngioJet 机械性导管溶栓（PCDT）联合与单独抗凝治疗 CAT 患者的安全性和有效性。我们回顾性分析了 2016 年 8 月 1 日至 2022 年 3 月 1 日期间接受 PCDT 和/或抗凝治疗 CAT 的患者。每位患者分为 PCDT 组或单独抗凝组。回顾了基线人口统计学、合并症、临床特征、治疗细节、病程数据。共纳入 51 例符合条件的患者，其中 21 例在 PCDT 组（平均年龄 60.1±13.0 岁；52.4%为男性），30 例在单独抗凝组（平均年龄 66.6±11.1 岁；50.0%为男性）。两组在年龄、性别、发病时间、肢体特征、癌症情况或危险因素方面无显著差异（p＞0.05）。PCDT 后，8 例达到 III 级溶解，11 例达到 II 级溶解。90.5%（19/21）的患者达到临床成功。两组的腿部疼痛和肿胀症状均明显改善。除 PCDT 组发生一过性肉眼血尿外，所有患者均未发生与治疗相关的主要并发症。PCDT 组 23.8%（5/21）的患者发生轻微并发症，如出血事件，而单独抗凝组为 10.0%（3/30）（p＞0.05）。6 个月随访时，髂股静脉通畅率绝对风险降低 37.9%（70.0% vs. 32.1%）（95%CI：1.183-4.008%；P=0.010）。PCDT 组轻度 PTS 发生率为 5.0%（1/20），单独抗凝组为 10.7%（3/28）（p＞0.05）。PCDT 治疗 CAT 患者是一种安全有效的方法，可改善临床结局，且并发症发生率低。PCDT 在缓解症状和保持静脉通畅方面比单独抗凝更有效。
