Patency and reflux in relation to postthrombotic syndrome: a subanalysis of the Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome trial

IF 5.5 2区医学 Q1 HEMATOLOGY

Journal of Thrombosis and Haemostasis Pub Date : 2024-12-01 DOI:10.1016/j.jtha.2024.08.022

Ruben D. Hupperetz , Aaron F.J. Iding , Jorinde van Laanen , Rutger Brans , Pascale Notten , Lidwine W. Tick , Louis-Jean Vleming , Asiong Jie , Nils Planken , Cees H.A. Wittens , Hugo ten Cate , Arina J. ten Cate-Hoek

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引用次数: 0

Abstract

Background

Adjunctive catheter-directed thrombolysis shows variable efficacy in preventing postthrombotic syndrome (PTS), despite restored patency.

Objectives

This Ultrasound-Accelerated Catheter-Directed Thrombolysis Versus Anticoagulation for the Prevention of Post-Thrombotic Syndrome (CAVA) trial subanalysis investigated the effect of ultrasound-accelerated catheter-directed thrombolysis (UACDT) on patency, reflux, and their relevance in PTS development.

Methods

This multicenter, randomized, single-blind trial enrolled patients (aged 18-85 years) with a first iliofemoral deep vein thrombosis and symptom duration ≤14 days. Patency and reflux were assessed by duplex ultrasound at 12 months (T12) and long-term (LT) follow-up (median, 39.5 months; IQR, 24.0-63.0 months). PTS was diagnosed using the Villalta score.

Results

UACDT significantly improved patency in all vein segments at T12 (60.3% UACDT vs 25.9% standard treatment [ST]; P = .002) and LT (45.2% UACDT vs 11.9% ST; P < .001). Popliteal patency, however, was similar between groups (87.9% UACDT vs 83.3% ST; P = .487). Reflux was similar between groups at T12 and LT; only popliteal reflux was significantly reduced in the UACDT group at LT (22.6% UACDT vs 44.8% ST; P = .010). Absent iliac patency at T12 was associated with increased PTS risk in the ST group only (odds ratio [OR], 10.84; 95% CI, 1.93-60.78; P = .007). In the UACDT group, popliteal reflux at T12 was associated with moderate-to-severe PTS at T12 (OR, 4.88; 95% CI, 1.10-21.57; P = .041) and LT (OR, 5.83; 95% CI, 1.44-23.63; P = .009). Combined popliteal reflux and absent iliac patency significantly amplified PTS risk (OR, 10.79; 95% CI, 2.41-48.42; P < .001).

Conclusion

UACDT improved patency and reduced popliteal reflux. Iliac patency and popliteal reflux are independently associated with moderate-to-severe PTS and contribute synergistically to its development. However, a proportion of moderate-to-severe PTS cases lacks an evident underlying cause.

查看原文本刊更多论文

血栓后综合征的通畅与回流：超声加速导管引导溶栓与抗凝治疗预防血栓后综合征试验的子分析。

背景：辅助性导管引导溶栓（CDT）在预防血栓后综合征（PTS）方面的疗效不一，尽管其通畅性已经恢复：这项CAVA试验的子分析研究了超声加速（UA）CDT对通畅性和回流的影响及其与PTS发展的相关性：这项多中心、随机、单盲试验招募了首次髂股深静脉血栓形成（DVT）且症状持续时间不超过14天的患者（18-85岁）。12个月（T12）和长期（LT）随访（中位数为39.5（24.0-63.0）个月）时，通过双工超声（DUS）评估了通畅和反流情况。采用 Villalta 评分诊断 PTS：结果：UACDT明显改善了T12（60.3% UACDT vs. 25.9% 标准治疗（ST），P=0.002）和LT（45.2% UACDT vs. 11.9% ST，P结论：UACDT改善了通畅性，减少了腘窝回流。髂骨通畅和腘窝反流与中重度 PTS 独立相关，并对其发展起到协同作用。然而，一部分中度重度 PTS 病例缺乏明显的潜在病因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Thrombosis and Haemostasis 医学-外周血管病

CiteScore

24.30

自引率

3.80%

发文量

321

审稿时长

1 months

期刊介绍： The Journal of Thrombosis and Haemostasis (JTH) serves as the official journal of the International Society on Thrombosis and Haemostasis. It is dedicated to advancing science related to thrombosis, bleeding disorders, and vascular biology through the dissemination and exchange of information and ideas within the global research community. Types of Publications: The journal publishes a variety of content, including: Original research reports State-of-the-art reviews Brief reports Case reports Invited commentaries on publications in the Journal Forum articles Correspondence Announcements Scope of Contributions: Editors invite contributions from both fundamental and clinical domains. These include: Basic manuscripts on blood coagulation and fibrinolysis Studies on proteins and reactions related to thrombosis and haemostasis Research on blood platelets and their interactions with other biological systems, such as the vessel wall, blood cells, and invading organisms Clinical manuscripts covering various topics including venous thrombosis, arterial disease, hemophilia, bleeding disorders, and platelet diseases Clinical manuscripts may encompass etiology, diagnostics, prognosis, prevention, and treatment strategies.