Pharmaco-Mechanical Thrombectomy vs. Conventional Anticoagulant Management of Acute Lower Extremity Deep Vein Thrombosis - Long-Term Outcomes

Objective: In this study, we aimed to evaluate the long-term effects of pharmaco-mechanical thrombectomy and compare its effi ciency and safety against anticoagulation together with the use of compression stockings in patients with proximal deep vein thrombosis of the lower extremity. Methods: A total of 228 patients, between January 2013 and January 2020, who presented to the clinic with acute deep vein thrombosis of the lower extremity were investigated retrospectively. There were 112 patients in the anticoagulation following pharmacomechanical thrombectomy group (Group 1) and 116 patients in the conventional anticoagulation with compression stockings group (Group 2). Results: There was no signifi cant difference in the post-thrombotic syndrome occurrence assessed with Villalta Scores at 6-month follow-up. However; at 12-, 24and 36-month follow-up, the incidence of the post-thrombotic syndrome was lower in the Group 1 compared to Group 2 (21.4%, 30.3%, 36.6% vs. 33.6%, 53.4%, 61.2%). Insuffi cient recanalization was present in 41 of 112 patients at 36 months in the Group 1, and in 71 of 116 patients in Group 2 at 36 months; correlating to an absolute risk reduction of 25.6% (95% CI 9.2–37.5; p = 0.001). The recurrent thrombosis rates in the Group 2 were signifi cantly higher than Group 1 (18.9% vs 7.1%; p = 0.002) in the 6to 36-month follow-up. Conclusion: The results of our study demonstrated that pharmacomechanical thrombectomy is a safe and effective treatment modality in case of lower extremity acute deep vein thrombosis. It has been associated with reduced post-thrombotic syndrome and recurrent venous thrombosis rates in the long-term follow-up when compared with the anticoagulation and compression stockings. Klíčová slova: Antikoagulační léčba Farmakomechanická terapie (pharmaco-mechanical therapy, PMT) Hluboká žilní trombóza (deep vein thrombosis, DVT) Posttrombotický syndrom (PTS)