Predictors of early resistance to catheter-directed thrombolysis in patients with proximal deep vein thrombosis

IF 3.3 3区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

European Journal of Radiology Pub Date : 2025-08-18 DOI:10.1016/j.ejrad.2025.112370

Maofeng Gong, Cheng Qian, Xu He, Jianping Gu, Guoping Chen

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引用次数: 0

Abstract

Purpose

To determine predictors of immediate thrombolysis resistance (iTR) in patients with proximal deep vein thrombosis (DVT), defined as thrombosis involving the femoral or more proximal veins, with or without concomitant popliteal vein involvement, and to investigate its impact on long-term post-thrombotic syndrome (PTS) outcomes.

Methods

This single-center retrospective study reviewed consecutive patients who underwent catheter-directed thrombolysis (CDT) as first-line therapy. Baseline demographics, clinical history, comorbidities and provoking risk factors for DVT, intraprocedural findings, periprocedural complications, and follow-up outcomes were compared between the iTR and immediate thrombolysis success (iTS) groups.

Results

182 patients (median age, 59.5 years; 53.3 % female) were included, with an iTR incidence of 13.7 % (25/182). After adjusting for body mass index, age (adjusted odds ratio [aOR] 0.95; 95 % confidence interval [CI], 0.92–0.99; p = 0.007), cancer (aOR 9.19; 95 % CI, 2.17–38.86; p = 0.003), urokinase use (aOR 6.69; 95 % CI, 1.78–25.19; p = 0.005), and absence of popliteal venous inflow (aOR 0.15; 95 % CI, 0.04–0.50; p = 0.002) were independent predictors of iTR. The overall complication rate was 10.4 % (19/182), with no significant difference between two groups (p > 0.05). At a median follow-up of 24 months, patients with iTR had a significantly higher incidence of PTS compared to those with iTS (hazard ratio 8.81; 95 % CI: 3.01–25.83; p < 0.001).

Conclusion

CDT is beneficial for the majority of selected patients with proximal DVT and low bleeding risk. Younger age, cancer presence, urokinase use, and absence of popliteal venous inflow were independent predictors of iTR. iTR significantly increased the risk of developing long-term PTS.

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近端深静脉血栓形成患者早期抗导管溶栓的预测因素

目的确定近端深静脉血栓形成（DVT）患者立即溶栓抵抗（iTR）的预测因素，定义为血栓累及股静脉或更多近端静脉，伴或不伴腘静脉受累，并探讨其对长期血栓后综合征（PTS）预后的影响。方法本单中心回顾性研究回顾了连续接受导管定向溶栓（CDT）作为一线治疗的患者。比较iTR组和立即溶栓成功组（iTS）的基线人口统计学、临床病史、合并症和诱发DVT的危险因素、术中发现、术中并发症和随访结果。结果纳入182例患者（中位年龄59.5岁，女性53.3%），iTR发生率为13.7%（25/182）。调整体重指数后，年龄（校正优势比[aOR] 0.95； 95%可信区间[CI]， 0.92-0.99; p = 0.007）、癌症（aOR 9.19; 95% CI, 2.17-38.86; p = 0.003）、尿激酶使用（aOR 6.69; 95% CI, 1.78-25.19; p = 0.005）和腘静脉流入缺失（aOR 0.15; 95% CI, 0.04-0.50; p = 0.002）是iTR的独立预测因子。总并发症发生率为10.4%(19/182)，两组比较差异无统计学意义（p > 0.05）。在中位随访24个月时，iTR患者的PTS发生率明显高于iTS患者（风险比8.81;95% CI: 3.01-25.83; p < 0.001）。结论cdt对大多数近端深静脉血栓患者均有较好的治疗效果，且出血风险低。年龄较小、癌症存在、尿激酶使用和腘静脉无流入是iTR的独立预测因素。iTR显著增加了发生长期PTS的风险。

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

European Journal of Radiology 医学-核医学

CiteScore

6.70

自引率

3.00%

发文量

398

审稿时长

42 days

期刊介绍： European Journal of Radiology is an international journal which aims to communicate to its readers, state-of-the-art information on imaging developments in the form of high quality original research articles and timely reviews on current developments in the field. Its audience includes clinicians at all levels of training including radiology trainees, newly qualified imaging specialists and the experienced radiologist. Its aim is to inform efficient, appropriate and evidence-based imaging practice to the benefit of patients worldwide.