RT info:eu-repo/semantics/article
T1 Effect of anticoagulant therapy in tehe incidence of post-throbotic syndrome and recurrent thromboemboembolism : comparative study of euoxeparin versus coumarin
A1 González Fajardo, José Antonio
A1 Martín Pedrosa, Miguel
A1 Castrodeza Sanz, José Javier
A1 Tamames Gómez, Sonia
A1 Vaquero Puerta, Carlos
K1 Síndrome post-trombótico
K1 Terapia quirúrgica
AB Objective: We evaluated the effect of long-term anticoagulant treatment (enoxaparin vs coumarin) in patients with deepvenous thrombosis (DVT) as to incidence of post-thrombotic syndrome (PTS) and recurrent venous thromboembolism.We also analyzed the impact of thrombus regression after the anticoagulant treatment for these two outcomes.Methods: A prospective study was designed in which 165 patients with symptomatic, unilateral, first-episode DVT wererandomized to a long-term anticoagulant treatment with coumarin or enoxaparin during at least 3 months. The rate ofthrombus regression was defined as the difference in Marder score after 3 months of treatment by venography. Follow-upwas performed at 3, 6, and 12 months, and yearly thereafter for 5 years. Venous disease was related to pathologic severityof PTS according to the validated scale of Villalta as rated by a physician blinded to treatment. Recurrence of symptomaticvenous thromboembolism was documented objectively.Results: The 5-year follow-up period was completed for 100 patients (enoxaparin, 56; coumarin, 44). A lesser incidenceof PTS was observed in the enoxaparin group (39.3% absent, 19.6% severe) than in the coumarin group (29.5% absent,29.5% severe), although this difference was not statistically significant. The accumulated recurrence rate was 19.3% withenoxaparin compared with 36.6% with coumarin (P   .02). Although the mean Marder score was significantly improvedin both groups (49.1% for enoxaparin vs 24.0% for coumarin; P   .016), a lower reduction in thrombus size wasassociated with higher clinical events of recurrence (hazard ratio   1.97; 95% CI, 1.06-3.66; P   .032). A significantinverse correlation was also found between the degree of thrombus regression at 3 months and the incidence at 5 yearsof PTS (P   .007).Conclusions: Residual venous thrombosis is an important risk factor for recurrent thromboembolism and PTS. A greaterreduction in thrombus size was associated with lesser clinical events of recurrence and consequently a lesser rate of PTS.However, despite a greater recanalization with enoxaparin, the incidence of PTS was similar between both treatmentgroups, probably because of the small sample size. Further investigations are needed to clarify the implication of theanticoagulant treatment in the severity of PTS. (J Vasc Surg 2008;48:953-9.)
PB Society of Vascular Surgery
SN 0741-5214
YR 2008
FD 2008
LK http://uvadoc.uva.es/handle/10324/3195
UL http://uvadoc.uva.es/handle/10324/3195
LA eng
NO Journal of Vascular Surgery, Octubre 2008, vol. 48, n.4. p.953-959.
NO Producción Científica
DS UVaDOC
RD 26-dic-2024