Objective

To compare the comparative effects of treatment with contemporary mechanical thrombectomy or anticoagulation on Villalta scores and post thrombotic syndrome incidence through 12 months in iliofemoral deep vein thrombosis.

Methods

Patients with deep vein thrombosis in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) randomized trial and the ClotTriever Outcomes (CLOUT) registry were included in this analysis. Both studies evaluated the effects of thrombus removal on the incidence of post thrombotic syndrome. Patients with bilateral deep vein thrombosis, isolated femoral-popliteal deep vein thrombosis, symptom duration >4 weeks, or incomplete case data for matching covariates were excluded. Propensity scores were used to match patients 1:1 that received anticoagulation (from ATTRACT) to those treated with mechanical thrombectomy (from CLOUT) using nearest neighbor matching on 9 baseline covariates, including age, body mass index, leg treated, provoked deep vein thrombosis, prior venous thromboembolism, race, sex, Villalta score, and symptom duration. Clinical outcomes, including Villalta score and post thrombotic syndrome, were assessed. Logistic regression was used to estimate the likelihood of developing post thrombotic syndrome at 12 months.

Results

A total of 164 pairs were matched, with no significant differences in baseline characteristics after matching. There were fewer patients with any post thrombotic syndrome at 6 months (19% vs 46%, p<.001) and 12 months (17% vs 38%, p<.001) in the mechanical thrombectomy treatment group. Modeling revealed that after adjusting for baseline Villalta scores, patients treated with anticoagulation had significantly higher odds of developing any post thrombotic syndrome (OR=3.1, 95% CI [1.5 to 6.2], p=.002) or moderate to severe post thrombotic syndrome (OR=3.1, 95% CI [1.1 to 8.4], p=.027) at 12 months compared with those treated with mechanical thrombectomy. Mean Villalta scores were lower through 12 months among those receiving mechanical thrombectomy vs anticoagulation (3.3 vs 6.3 at 30 days, 2.5 vs 5.5 at 6 months, and 2.6 vs 4.9 at 12 months, p<.001 for all).

Conclusions

Mechanical thrombectomy treatment of iliofemoral deep vein thrombosis was associated with significantly lower Villalta scores and reduced incidence of post thrombotic syndrome through 12 months compared with treatment using anticoagulation. Results from currently enrolling clinical trials will further clarify the role of these therapies in the prevention of post thrombotic syndrome following an acute deep vein thrombosis event.

中文翻译：

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抗凝与机械取栓治疗髂股深静脉血栓的比较

客观的

比较当代机械血栓切除术或抗凝治疗对髂股深静脉血栓形成 12 个月内 Villalta 评分和血栓后综合征发生率的比较效果。

方法

本次分析纳入了急性静脉血栓形成：辅助导管定向溶栓 (ATTRACT) 随机试验和 ClotTriever 结果 (CLOUT) 登记中的深静脉血栓患者。这两项研究都评估了血栓清除对血栓后综合征发生率的影响。排除双侧深静脉血栓、孤立性股腘深静脉血栓、症状持续时间 > 4 周或匹配协变量病例数据不完整的患者。使用倾向评分将接受抗凝治疗（来自 ATTRACT）的患者与接受机械血栓切除术（来自 CLOUT）的患者进行 1:1 匹配，使用 9 个基线协变量的最近邻匹配，包括年龄、体重指数、腿部治疗、引发的深静脉血栓形成、既往静脉血栓栓塞史、种族、性别、Villalta 评分和症状持续时间。评估了临床结果，包括 Villalta 评分和血栓后综合征。Logistic 回归用于估计 12 个月时发生血栓后综合征的可能性。

结果

总共匹配了164对，匹配后基线特征没有显着差异。在机械取栓治疗组中，6 个月（19% vs 46%，p<.001）和 12 个月（17% vs 38%，p<.001）时出现任何血栓后综合征的患者较少。建模显示，调整基线 Villalta 评分后，接受抗凝治疗的患者发生任何血栓后综合征（OR=3.1，95% CI [1.5 至 6.2]，p=.002）或中度至重度血栓后综合征的几率显着更高与接受机械血栓切除术治疗的患者相比，12 个月时（OR=3.1，95% CI [1.1 至 8.4]，p=0.027）。接受机械血栓切除术与抗凝治疗的患者在 12 个月期间的平均 Villalta 评分较低（30 天时为 3.3 vs 6.3，6 个月时为 2.5 vs 5.5，12 个月时为 2.6 vs 4.9，全部 p<0.001）。

结论

与抗凝治疗相比，机械取栓治疗髂股深静脉血栓可显着降低 Villalta 评分，并降低 12 个月内血栓后综合征的发生率。目前招募的临床试验结果将进一步阐明这些疗法在预防急性深静脉血栓形成事件后血栓后综合征中的作用。