Novosti
Khirurgii

 This journal is
indexed in Scopus
journal cover
android icon Android Applicaion

Year 2015 Vol. 23 No 4

GENERAL & SPECIAL SURGERY

R.E. KALININ, I.A. SUCHKOV, A.S. PSHENNIKOV, A.B. AGAPOV

EVALUATION OF EFFICACY AND SAFETY OF DIFFERENT TYPES OF ANTICOAGULANT THERAPY IN VENOUS THROMBOSIS

SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov",
The Russian Federation

Objectives. Evaluation of efficacy and safety of different types of anticoagulant therapy (ACT) in patients with deep venous thrombosis (DVT).
Methods. The study included 119 patients with the disease duration of 1 to 15 days. The patients were divided into three groups: the 1st group included patients (n=38) received rivaroxaban, the 2nd group included patients (n=42) who received sodium enoxaparin (for 7-10 days) with subsequent administration of warfarin, the 3rd group included patients (n=39) treated with sodium enoxaparin (for 7-10 days) with subsequent administration of rivaroxaban. The efficacy and safety of ACT were assessed by duplex ultrasonography, by recurrence incidence and hemorrhagic complications.
Results. The increase in thrombus length was observed in 24% patients in the 1st group by the 4-5th days. These patients were then treated with enoxaparin which resulted in the subsequent apex attachment to the vein wall by the 12th days.
The apex of the free-floating thrombus was attached to the vein wall by the 8-10th days in 76% of patients who received rivaroxaban. DVT duration in 4 patients (24%) did not exceed 10 days, in 14 patients (76%) it was less than 5 days. In the 2nd group the apex of the thrombus attached to the vein wall by the 8-10th day in 17 patients, while in 2 patients (5%) the free-floating thrombi were detected after more than 12 days of treatment. In group 3 the apex of the free-floating thrombus was attached to the vein wall by the 8-10th days in all patients. After 1 month of rivaroxaban treatment, the recanalization was regarded as satisfactory. Recanalization in patients treated with warfarin was considered as "moderate" or "poor". The complications caused to anticoagulant therapy developed in 20 (16,8%) out of 119 patients. The significant and major complications were observed in warfarin group.
Conclusion. Parenteral administration of anticoagulants is considerted to be an effective method of lysis of free-floating thrombi in patients with different disease duration. Rivaroxaban has more advantages compared with warfarin in early terms of satisfactory recanalization, and causes fewer major hemorrhagic complications.

Keywords: deep vein thrombosis, ultrasound duplex scanning, anticoagulant therapy, attachment of thrombus, rivaroxaban, warfarin, hemorrhagic complications
p. 416-423 of the original issue
References
  1. Vardanian AV, Badanian AL, Mumladze RB, Patrushev LI, Roitman EV, Dolidze DD, Tokarev KIu. Idiopaticheskii tromboz glubokikh ven: sovremennye podkhody k diagnostike i lecheniiu [Idiopathic deep venous thrombosis: the current approaches to diagnosis and treatment]. Flebologiia. 2014;8(2):16-20.
  2. Savel'ev VS, Chazov EI, Gusev EI, Kirienko AI. Rossiiskie klinicheskie rekomendatsii po diagnostike, lecheniiu i profilaktike venoznykh tromboembolicheskikh oslozhnenii [Russian clinical recommendations for diagnosis, treatment and prevention of venous thromboembolic events]. Flebologiia. 2010;4(2):3-37
  3. Kalinin RE, Suchkov IA, Narizhnyi MV. Dispanserizatsiia bol'nykh s venoznymi tromboembolicheskimi oslozhneniiami [Clinical examination of patients with venous thromboembolic complications]. Ross Med-Biol Vestnk Im Akad IP Pavlova. 2011;(3):104-109.
  4. Lemenev VL, Kurguntsev EV, Gol'dina IM, Trofimova EIu, Mikhailov IP, Kudriashova NE. Klinicheskaia i ul'trazvukovaia diagnostika ostrykh venoznykh trombozov [Clinical and ultrasound diagnosis of acute venous thrombosis]. Khirurgiia. Zhurn im NI Pirogova. Moscow, RF: Media Sfera. 2008;(5):11-16.
  5. Shval'b PG, Kalinin RE, Egorov AA, Kachinskii AE. Real'naia embologennost' trombozov ven nizhnikh konechnostei [Real embologenic venous thrombosis of lower extremities]. Angiologiia i Sosud Khirurgiia. 2004;10(2):81-83.
  6. Schwarz UI, Ritchie MD, Bradford Y, Li C, Dudek SM, Frye-Anderson A, Kim RB, Roden DM, Stein CM. Genetic determinants of response to warfarin during initial anticoagulation. N Engl J Med. 2008 Mar 6;358(10):999-1008. doi: 10.1056/NEJMoa0708078.
  7. Baker WL, Cios DA, Sander SD, Coleman CI. Meta-analysis to assess the quality of warfarin control in atrial fibrillation patients in the United States. J Manag Care Pharm. 2009 Apr;15(3):244-52.
  8. Sukovatykh BS, Mikhin VP, Belikov LN, Cherniatina MA, Gladchenko MP, Savchuk OF. Optimizatsiia antikoaguliantnoi terapii venoznogo tromboembolizma [Optimization of anticoagulant therapy of venous thromboembolism]. Angiologiia i Sosud Khirurgiia. 2014;20(3):95-100.
  9. Khruslov MV. Problemy kontrolia effektivnosti profilaktiki retsidiva venoznykh tromboembolicheskikh oslozhnenii [Monitoring problems of the effectiveness of the recurrence prevention of venous thromboembolic events]. Flebologiia. 2014;(4):37-41.
  10. Bauersachs R, Berkowitz SD, Brenner B, Buller HR, Decousus H, Gallus AS, Lensing AW, Misselwitz F, Prins MH, Raskob GE, Segers A, Verhamme P, Wells P, Agnelli G, Bounameaux H, Cohen A, Davidson BL, Piovella F, Schellong S. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010 Dec 23;363(26):2499-510. doi: 10.1056/NEJMoa1007903
  11. Moiseev SV. Novye peroral'nye antikoagulianty v lechenii venoznykh tromboembolicheskikh oslozhnenii [New oral anticoagulants in the treatment of venous thromboembolic events]. Flebologiia. 2012;(1):32-36.
  12. Sushkov SA, Nebylitsin IS, Samsonova IV, Markautsan PV. Morfologicheskie izmeneniia sosudistoi stenki v raznye stadii eksperimental'nogo venoznogo tromboza [The morphological changes of the vascular wall at different stages of experimental venous thrombosis]. Ross Med-Biol Vestn Im Akad IP Pavlova. 2014;(3):17-27.
  13. Tsukanov IuT, Nikolaichuk AI. Otsenka faktorov, vliiaiushchikh na regress tromba podkozhnykh ven nizhnikh konechnostei pri antikoaguliantnoi terapii [Factors influencing the regression of the thrombus saphenous veins of the lower extremities during anticoagulant therapy]. Novosti Khirurgii. 2015;23(1):57-62.
  14. Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation. An update of the 2010 ESC Guidelines for the management of atrial fibrillation. ESC Committee for Practice Guidelines (CPG). Eur Heart J. 2012 Nov;33(21):2719-47. doi: 10.1093/eurheartj/ehs253
Address for correspondence:
390048, Russian Federation,
Ryazan, ul. Stroykova, d. 96,
GBOU VPO "Ryazanskiy gosudarstvennyiy
meditsinskiy universitet
imeni akademika I.P. Pavlova",
kafedra angiologii, sosudistoy,
operativnoy khirurgii i topograficheskoy anatomii,
tel. mob: 7 903 836-24-17,
e-mail: suchkov_med@mail.ru
Suchkov Igor Aleksandrovich
Information about the authors:
Kalinin R.E. MD, professor, a head of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Suchkov I.A. MD, an associate professor of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Pshennikov A.S. PhD, an assistant of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Agapov A.B. A day-time post-graduate student of the angiology, vascular, operative surgery and topographic anatomy chair of SBEE HPE "Ryazan State Medical University named after Academician I.P. Pavlov".
Contacts | ©Vitebsk State Medical University, 2007-2023