The prevalence of decompensated forms of venous insufficiency in patients after Deep venous thrombosis of the lower extremities who took warfarin
Abstract
Background. Insufficient knowledge of the effect of anticoagulants on the process of recanalization of the deep veins of the lower extremities after thrombosis makes the question of the choice of a drug for the treatment of this pathology relevant. Particularly noteworthy are the long-term consequences of thrombosis, for the treatment of which vitamin K antagonists (warfarin) were prescribed, which for many years were considered the "gold standard" in the treatment of venous thromboembolic complications (VTEC).
Aim – to establish the frequency of occurrence of decompensated forms of venous insufficiency in patients after suffering deep venous thrombosis of the lower extremities who took warfarin.
Material and methods. A prospective study involved 50 patients with deep vein thrombosis of the lower extremities treated in the Department of Vascular Surgery from 2007 to 2012. The average age of patients at the time of treatment was 44±12.6 years. Men 32 (64%), women 18 (36%). To diagnose the thrombotic process, all patients underwent ultrasound duplex scanning of the veins of the inferior vena cava system. The treatment regimen for patients included heparin administration, followed by a transition to a six-month intake of warfarin under the control of INR. Subsequently, adherence to treatment with warfarin, the use of elastic compression, the clinical and ultrasound picture of the state of the venous system, and the quality of life of patients were evaluated.
Results. 18 (36%) patients stopped taking warfarin before 6 months. Reccurence of VTEC was observed in 13 (26%) patients. In 2 (4%) people recurrence of thrombosis was complicated by puimonary embolism. Elastic compression was used irregularly. When ultrasound of the veins of the lower extremities was observed negative dynamics of patency even previously intact veins. Clinically, more than 30% of patients had decompensated forms of chronic venous insufficiency by the fifth year of observation. The assessment of the quality of life of patients corresponded to the clinical picture of the disease.
Discussion. Our findings are consistent with literature data. The poor condition of patients can be explained by the pharmacological properties of warfarin, low treatment adherence and recurrence of VTEC.
Conclusions. The inconvenience of taking warfarin and its inherent shortcomings makes it necessary to prescribe alternative drugs from the PLA group with proven effectiveness.
Keywords:deep vein thrombosis, anticoagulant therapy, chronic venous insufficiency
Conflict of interests. The authors declare no conflict of interests.
For citation: Poliantsev A.A., Frolov D.V., Linchenko D.V., Shchelokova Yu.V., Litvinova T.A., Dyachkova Yu.A. The prevalence of decompensated forms of venous insufficiency in patients after Deep venous thrombosis of the lower extremities who took warfarin. Clin Experiment Surg. Petrovsky J. 2020; 8 (1): 47–55. doi: 10.33029/2308-1198-2020-8-1-47-55 (in Russian)
Received 29.03.2019. Accepted 05.02.2020.
References
1. Prandoni P., Lensing A.W., Prins M.H., et al. Residual venous thrombosis as a predictive factor of recurrent venous thromboembolism. Ann Intern Med. 2002; 137 (12): 955–60. doi: https://doi.org/10.7326/0003-4819-137-12-200212170-00008.
2. Lobastov K.V., Barinov V.E., Schastlivcev I.V., et al. Modern approaches to the diagnosis and treatment of acute venous thrombosis. Moscow: Triumf; 2016. 261 p. (in Russian)
3. Ansell J., Hirsh E., Hylek E., et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edition). Chest. 2008; 133 (6): 160–98. doi: https://doi.org/10.1378/chest.08-0670.
4. Krylov A.I., Shulutko A.M., Serebriĭskiĭ I.I., et al. Criteria for the effectiveness of anticoagulant therapy in patients with deep vein thrombosis of the lower extremities. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2015; 21 (1): 36–43. (in Russian)
5. Ansell J., Hollowell J., Pengo V., et al. Descriptive analysis of the process and quality of oral anticoagulation management in real-life practice in patients with chronic non-valvular atrial fibrillation: the international study of anticoagulation management (ISAM). J Thromb Thrombol- ysis. 2007; 23 (2): 83–91. doi: https://doi.org/10.1007/s11239-006-9022-7.
6. Zolotuhin I.A., Jumin S.M, Leont'ev S.G. et al. Out-patient treatment after deep vein thrombosis: how do patients adhere to medical advice? Flebologiya [Phlebology]. 2010; 4 (2): 24–8. (in Russian)
7. Sukovatykh B.S., Sukovatykh M.B., Per’kov S.O. Treatment results of the deep venous thrombosis using oral anticoagulants. Annaly khirurgii [Annals of Surgery]. 2017; 22 (5): 278–83. doi: http://dx.doi.org/10.18821/1560-9502-2017-22-5-278-283. (in Russian)
8. Kuznetsov M.R., Leontev S.G., Sapelkin S.V. Recanalization of deep veins of the lower extremities as an indicator of the effectiveness of treatment of acute venous thrombosis. Angiologiya i sosudistaya khirurgiya [Angiology and Vascular Surgery]. 2016; 22 (3): 82–7. (in Russian)
9. Shcheglov E.A., Alontzeva N.N. Current study aimed to highlight extent of clot resolution in deep veins and its association with anticoagulation pattern in VTE patients. Khirurgiya. Zhurnal imeni N.I. Pirogovа [Pirogov Russian Journal of Surgery]. 2017; 4: 56–60. doi: 10.17116/hirurgia2017456-60. (in Russian)
10. Prostov I.I., Katelnitsky I.I., Katelnitskaya O.V. The long-term results of treatment of thrombosis of deep veins of lower extremities and their complications. Kubanskiy nauchnyy meditsinskiy vestnik [Kuban Scientific Medical Bulletin]. 2013; 4 (139): 84–6. (in Russian)
11. Young L., Ockelford P., Milne D., et al. Post-treatment residual thrombus increases the risk of recurrent deep vein thrombosis and mortality. J Thromb Haemost. 2006; 4 (9): 1919–24. doi: https://doi.org/10.1111/j.1538-7836.2006.02120.x.
12. Stockaja T.V., Vasil’eva E.V., Suhanova G.A. A method for the treatment of subacute venous thrombosis of various localization. 2014. RF patent N 2530645, cl. A61K31/4439.
13. Heit J.A., Spencer F.A., White R.H. The epidemiology of venous thromboembolism. J Throm Thrombolysis. 2016; 41 (1): 3–14. doi: https://doi.org/10.1007/s11239-015-1311-6.
14. Piovella F, Crippa L, Barone M., et al. Normalization rates of compression ultrasonography in patients with a first episode of deep vein thrombosis of the lower limbs: association with recurrence and new thrombosis. Haematologica. 2002; 87 (5): 515–22.
15. Ageno W., Mantovani L. G., Haas S., et al. Safety and effectiveness of oral rivaroxaban versus standard anticoagulation for the treatment of symptomatic deep vein thrombosis (XALIA): an international prospective non-interventional study. Lancet Haematol. 2016; 3 (1): e12–e21. doi: https://doi.org/10.1016/s2352-3026(15)00257-4.
16. The EINSTEIN Investigators. Oral Rivaroxaban for Symptomatic Venous Thromboembolism. N Engl J Med. 2010; 363 (26): 2499–510. doi: https://doi.org/10.1056/nejmoa1007903.
17. Krivoshchekov EP, Migunov I.A. A modern approach to the treatment of acute deep vein thrombosis with rivaroxaban Arkhiv vnutrenney meditsiny [The Russian Archives of Internal Medicine]. 2015; 3 (23): 75–8. (in Russian)
18. Ammollo C.T., Semeraro F., Incampo F., et al. Dabigatran enhances clot susceptibility to fibrinolysis by mechaninsms dependent of thrombinactivatable fibrinolysis ingibitor. J Thromb Haemost. 2010; 8 (4): 790–8. doi: https://doi.org/10.1111/j.1538-7836.2010.03739.x.
19. Agnelli G., Buller H.R., Cohen A., et al. Apixaban for extended treatment of venous thromboembolism. N Engl J Med. 2013; 368 (8): 699–708. doi: https://doi.org/10.1056/nejmoa1207541.