Division of Vascular and Endovascular Surgery, Department of Surgery, Gyeongsang National University Changwon Hospital, Changwon, South Korea.
Division of Vascular and Endovascular Surgery, Department of Surgery, Kyungpook National University Hospital, Daegu, South Korea.
J Vasc Surg Venous Lymphat Disord. 2024 Sep;12(5):101903. doi: 10.1016/j.jvsv.2024.101903. Epub 2024 May 15.
Non-vitamin K antagonist oral anticoagulants have shown similar efficacy and lower bleeding rates than vitamin K antagonists for venous thromboembolism. However, this has not been proven in mesenteric vein thrombosis. This study aimed to compare the clinical outcomes of vitamin K antagonists and non-vitamin K antagonist oral anticoagulants.
Between January 2014 and July 2022, mesenteric vein thrombosis was diagnosed on computed tomography in 225 patients in a tertiary hospital. Among them, a total of 44 patients who underwent long-term anticoagulation therapy over 3 months were enrolled in this study. Patients were divided into two groups based on the anticoagulant used: vitamin K antagonists (Group 1, n = 21) and non-vitamin K antagonist oral anticoagulants (Group 2, n = 23). The efficacy outcomes were symptom recurrence and thrombus resolution on follow-up computed tomography, and the safety outcome was bleeding complications.
The median age of the patients was 56 years (range, 46-68 years), and 52% were men. The most common risk factors were unprovoked intra-abdominal infections (30%). The median duration of anticoagulation therapy was 13 months (20 months in Group 1 vs 6 months in Group 2; P = .076). Of the 44 patients, 17 (39%) received the standard treatment. The median follow-up period was longer in Group 1 than in Group 2 (57 vs 28 months; P = .048). No recurrence of mesenteric vein thrombosis-related symptoms were observed in either group. The median duration of follow-up computed tomography was 31 months (42 months in Group 1 vs 18 months in Group 2; P = .064). Computed tomography revealed complete thrombus resolution, partial resolution, and no changes in 71%, 19%, and 10%, respectively (P = .075). Regarding bleeding complications, varix bleeding and melena developed in two patients in Group 2, and anticoagulation treatment thereafter ceased.
Despite the short follow-up duration in the non-vitamin K antagonist oral anticoagulants group, there was no clinically significant difference in the thrombus resolution rate or bleeding complications when compared with the vitamin K antagonists group. Although research on the long-term effects of non-vitamin K antagonist oral anticoagulants in patients is limited, non-vitamin K antagonist oral anticoagulants can be considered an alternative to conventional treatments.
非维生素 K 拮抗剂口服抗凝剂在治疗静脉血栓栓塞症方面的疗效与维生素 K 拮抗剂相当，且出血风险更低。然而，这在肠系膜静脉血栓形成中尚未得到证实。本研究旨在比较维生素 K 拮抗剂和非维生素 K 拮抗剂口服抗凝剂的临床结局。
2014 年 1 月至 2022 年 7 月，在一家三级医院的计算机断层扫描中诊断出 225 例肠系膜静脉血栓形成患者。其中，共有 44 例患者接受了 3 个月以上的长期抗凝治疗，被纳入本研究。根据使用的抗凝剂将患者分为两组：维生素 K 拮抗剂（组 1，n=21）和非维生素 K 拮抗剂口服抗凝剂（组 2，n=23）。疗效结局为随访计算机断层扫描上的症状复发和血栓溶解情况，安全性结局为出血并发症。
患者的中位年龄为 56 岁（范围 46-68 岁），52%为男性。最常见的危险因素是无明显诱因的腹腔内感染（30%）。抗凝治疗的中位持续时间为 13 个月（组 1 为 20 个月，组 2 为 6 个月；P=0.076）。44 例患者中，17 例（39%）接受了标准治疗。组 1 的中位随访时间长于组 2（57 个月比 28 个月；P=0.048）。两组均未观察到肠系膜静脉血栓形成相关症状复发。中位随访计算机断层扫描时间为 31 个月（组 1 为 42 个月，组 2 为 18 个月；P=0.064）。计算机断层扫描显示，完全血栓溶解、部分溶解和无变化的比例分别为 71%、19%和 10%（P=0.075）。关于出血并发症，组 2 中有 2 例患者出现静脉曲张出血和黑便，此后停止抗凝治疗。
尽管非维生素 K 拮抗剂口服抗凝剂组的随访时间较短，但与维生素 K 拮抗剂组相比，血栓溶解率或出血并发症并无临床意义上的差异。尽管关于非维生素 K 拮抗剂口服抗凝剂在患者中的长期效果的研究有限，但非维生素 K 拮抗剂口服抗凝剂可以被视为传统治疗的替代方案。
