Evolving treatment strategies for deep venous thrombosis: long-term outcomes of pharmacomechanical thrombectomy with exploratory analysis of a cancer-associated subgroup in a retrospective cohort study.

Abstract

Purpose: Deep vein thrombosis (DVT) contributes significantly to the mortality and morbidity of patients with and without cancer. Non-vitamin K antagonist oral anticoagulants (NOACs) and endovascular interventions have been included in the guidelines for special populations, such as those with cancer-associated DVT. This study aimed to evaluate the long-term outcomes of pharmacomechanical thrombectomy (PMT) compared to NOAC therapy in patients with iliofemoral DVT, and to perform an exploratory subgroup analysis of cancer-associated cases.

Methods: This study included 126 patients who received only medical therapy (n = 66) and PMT (n = 60) for iliofemoral DVT. Of the patients who underwent PMT, 13 had cancer-associated DVT; 10 of them were in the NOAC group. All patients included in this study were retrospectively analyzed after 6 months and 1 year. The Villalta scale was used to measure the severity of post-thrombotic syndrome.

Results: Villalta scores 1 year after DVT onset showed a strong positive correlation with those 6 months after DVT onset (ρ = 0.803, P < 0.001). Cancer-associated DVT patients (n = 13) who underwent PMT showed superior 1-year Villalta scores than did cancer patients (n = 10) who received NOAC treatment (Villalta score,12 vs. 8). This difference was similar to that observed in the non-cancer-associated population who underwent PMT (Villalta score,11 vs. 8).

Conclusion: Acute proximal DVT, regardless of malignancy induction, can be treated with endovascular interventions along with medical therapies. The evolution and development of endovascular treatments for DVT can improve the declining quality of life among patients with cancer-associated DVT.