Journal «Angiology and Vascular Surgery» • 

2016 • VOLUME 22 • №3

Recanalization of lower-limb deep veins as an index of efficacy of treatment for acute venous thrombosis

Kuznetsov M.R.1, Sapelkin S.V.2, Boldin B.V.3, Leontiev S.G.1, Neskhodimov L.A.3

1) Chair of Faculty Surgery, Urology of the Therapeutic Faculty of the Russian National Research Medical University named after N.I. Pirogov,
2) Institute of Surgery named after A.V. Vishnevsky under the Public Health Ministry of the Russian Federation,
3) Chair of Faculty Surgery No 2, Russian National Research Medical University named after N.I. Pirogov, Moscow, Russia

The authors analysed the results of examination and treatment of a total of 102 patients presenting with iliofemoral venous thrombosis. During treatment, ultrasonographic duplex scanning was used to determine the localization of the proximal margin of thrombotic masses, the time of appearing of the first signs of recanalization, its degree at various levels of the deep venous system, as well as alteration in velocity of the venous blood flow in the deep veins of the lower limbs. The dynamics of clinical symptoms was assessed by the visual analogue scale. Clinical and instrumental examination was performed on day 10, and then 1, 3, 6 and 12 months after the beginning of treatment. The patients were subdivided into three groups. Group One comprised 38 patients receiving therapy with low-molecular-weight heparin (enoxaprin) followed by switching to indirect anticoagulants (warfarin) combined with venotonics (original highly-purified diosmin 600 mg once daily). Group Two was composed of 33 patients receiving rivaroxaban at a dose of 15 mg twice daily for 3 weeks, followed by 20 mg once daily. Group Tree patients (n=31) were also given rivaroxaban according to the above-described standard regimen but in combination with venotonics (original highly-purified diosmin 600 mg once daily).

The obtained findings showed that prescribing rivaroxaban to patients from the first day of the disease made it possible to considerably improve and accelerate the processes of restoration of patency of deep veins of lower extremities as compared with the patients taking vitamin K antagonists (warfarin). In patients receiving rivaroxaban, there were no cases of residual thrombotic occlusions of the major veins, and recanalization in three fourths of patients was assessed as good and in the remaining third as moderate. In the warfarin group, occlusion in the iliac veins was noted to persist persisted in 13% of patients, with good recanalization observed only in half of the patients. Addition of venotonics (original highly-purified diosmin) to anticoagulants from the first day demonstrated safety of this therapeutic regimen (with no cases of clinically significant haemorrhagic complications revealed) and its high efficacy as compared with monotherapy with rivaroxaban. A combination of diosmin with rivaroxaban turned out more efficient than a combination of diosmin with warfarin.

KEY WORDS: acute venous thrombosis, post-thrombotic disease, chronic venous insufficiency, anticoagulants, venotonics, rivaroxaban, warfarin, diosmin.

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