Objective: To explore the outcomes of anticoagulation, systematic thrombolysis and catheter-directed thrombolysis (CDT) in the treatment of lower extremity acute deep venous thrombosis (DVT).
Methods: The clinical data of 152 patients with lower extremity acute DVT from January 2005 to December 2009 were analyzed retrospectively. They were divided into single anticoagulation group (A), systematic thrombolysis plus anticoagulation group (B) and CDT plus anticoagulation group (C).Follow-up studies were performed to inquire about patient symptoms, check the status of affected extremities and examine venous patency with venous ultrasonography or anterograde venous radiography. The incidence rate of post-thrombotic syndrome (PTS) was evaluated with the Villalta score while the quality of life with CIVIQ-2 questionnaire. And the post-discharge anticoagulation time and use of compression stockings were analyzed in each group.
Results: (1)The venous patency rate was 69.1%, 70.8%, 85.1% in groups A, B and C respectively. The differences was significant between groups A and C (P < 0.05). The differences was insignificant between groups C and B (P > 0.05). And the venous patency rate of group C was higher than that of group B. The difference was insignificant between groups A and B (P > 0.05).Such remodeling effects as venous valvular destruction and intravenous wall thickening were observed in PTS patients with venous ultrasonography and anterograde venous radiography. (2) The incidence of PTS was 56.8%, 54.2%, 38.3% in groups A, B and C. Compared with groups A and B, the difference was significant in group C (P < 0.05). The difference was insignificant between groups A and B (P > 0.05). (3) CIVIQ-2 score was 20.2 ± 14.4, 20.1 ± 12.5, 16.6 ± 11.0 in groups A, B and C. Compared with groups A and B, the difference was insignificant in group C (P > 0.05). And it was lower in group C than groups A and B. (4) The differences of average anticoagulant time and compression stocking use were insignificant in 3 groups (P > 0.05).
Conclusion: Compared with anticoagulant and systematic thrombolysis, a combination of CDT and anticoagulation may reduce the risk for PTS, alleviate clinical symptoms and improve quality of life.