J Surg Ultrasound.  2020 Nov;7(2):29-35. 10.46268/jsu.2020.7.2.29.

Randomized Comparison of Thrombus Resolution Outcome between Direct Xa Inhibitor Anticoagulant and Warfarin In Acute Deep Vein Thrombosis

• Lee JH
• Park KH

• KMID: 2511914
• DOI: http://doi.org/10.46268/jsu.2020.7.2.29

Abstract

Purpose
Newly developed factor Xa inhibitor anticoagulants (Xaban) produced non-inferior outcomes in terms of venous thromboembolism (VTE) recurrence and safety. On the other hand, thrombus resolution (TR), a factor associated with VTE recurrence and post-thrombotic syndrome, was not expressed clearly in these studies. This study compared the long-term TR outcomes in patients treated with Xaban or warfarin.
Methods
Fifty-seven acute deep vein thrombosis (DVT) patients were enrolled. After the initial heparin therapy, randomly assigned patients received oral Xaban or warfarin. The time in the therapeutic range was maintained at more than 60% during the anticoagulation period. After 3–12 months on the medication, a duplex scan was performed to diagnose the thrombus changes.
Results
Unprovoked DVT occurred in 80.7% of patients (46/57), and the mean age was 60.1 ± 13.99 years; 26 patients were female. Concurrent pulmonary embolism was diagnosed in 20 patients (52.6%) in the Xaban group and 10 (52.6%) in the warfarin group. The complete TR rate for the proximal venous segment was 47.4% (18/38) for the Xaban group and 57.9% (11/19) for the warfarin group. Complete DVT TR was observed in 26.3% of patients (10/38) in the Xaban group and 42.1% (8/19) in the warfarin group. No significant difference was observed between the proximal (P = 0.657) and complete TR rates (P = 0.227) between the two groups.
Conclusion
Xaban administration for acute DVT showed no difference in TR compared to warfarin. Xaban could also be an easy-to-use anticoagulation treatment option because it does not require monitoring and has a short half-life.

Keyword

Deep vein thrombosis; Anticoagulants; Warfarin

Figure

• 

  Fig. 1 Thrombus in femoral vein was completely resolved after 6 months Xaban medication: (A) initial finding showed no color signal in color doppler view and (B) throm-bosed vein was not compressed; (C) after 6 months, flow was restored with color dopper view and (D) complete obliteration in compression test.

• 

  Fig. 2 After 6 months warfarin medication, partial resolution was observed: (A) Initial total occlusion with thrombus in popliteal vein; (B) after long-term medication, partial thrombus resolution with limited flow restoration.

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