Bardetta Marco, Simoncini Matteo, Valeri Federica, Pizzuto Andrea, Dainese Cristina, Sella Carola, Porreca Annamaria, Bruno Benedetto, Borchiellini Alessandra
Regional Centre for Hemorrhagic and Thrombotic Diseases, AOU Città della Salute e della Scienza, 10126 Turin, Italy.
Division of Hematology, AOU Città della Salute e della Scienza, 10126 Turin, Italy.
J Clin Med. 2025 Aug 25;14(17):5991. doi: 10.3390/jcm14175991.
After an initial course of anticoagulation for deep vein thrombosis (DVT), identifying patients at higher risk of recurrence remains a clinical challenge. The role of residual vein thrombosis (RVT) in this setting is still debated, as most available evidence derives from retrospective studies or from the Warfarin era. We conducted a study to evaluate the incidence of RVT in patients treated with direct oral anticoagulants (DOACs) and to identify the clinical factors associated with its persistence. We also compared the outcomes from the two most prescribed drugs in Italy, Apixaban and Rivaroxaban. A total of 113 patients with newly diagnosed DVT underwent follow-up visits at 6 weeks (T1), 3 months (T2) and 6 months (T3) after diagnosis. RVT was assessed by compression ultrasonography and clinical, family and pathological history data were collected. Ninety-six patients were included in the final statistical analysis. RVT was detected in 68.2%, 52.1% and 37.7% of patients at T1, T2 and T3, respectively. Factors significantly associated with RVT at T2 were male sex, femoral vein involvement and a family history of DVT. No significant differences were observed between Apixaban and Rivaroxaban. Prior episodes of thrombosis, smoking, diabetes and obesity were not associated with RVT at 3 months. Our findings confirm that RVT rates progressively decrease over time, as previously observed in the Coumarins era, but suggest a stronger early response to DOACs, particularly during the first three months of therapy. Moreover, DOACs appear to provide more effective protection in patients with risk factors for venous disease.
在对深静脉血栓形成（DVT）进行初始抗凝治疗后，识别复发风险较高的患者仍然是一项临床挑战。残余静脉血栓形成（RVT）在这种情况下的作用仍存在争议，因为大多数现有证据来自回顾性研究或华法林时代。我们进行了一项研究，以评估接受直接口服抗凝剂（DOACs）治疗的患者中RVT的发生率，并确定与其持续存在相关的临床因素。我们还比较了意大利最常用的两种药物阿哌沙班和利伐沙班的疗效。共有113例新诊断为DVT的患者在诊断后6周（T1）、3个月（T2）和6个月（T3）进行了随访。通过压迫超声评估RVT，并收集临床、家族和病理病史数据。96例患者纳入最终统计分析。在T1、T2和T3时，分别有68.2%、52.1%和37.7%的患者检测到RVT。与T2时RVT显著相关的因素为男性、股静脉受累和DVT家族史。阿哌沙班和利伐沙班之间未观察到显著差异。既往血栓形成发作、吸烟、糖尿病和肥胖与3个月时的RVT无关。我们的研究结果证实，RVT发生率随时间逐渐降低，如之前在香豆素时代所观察到的，但表明对DOACs的早期反应更强，尤其是在治疗的前三个月。此外，DOACs似乎为有静脉疾病危险因素的患者提供了更有效的保护。
