Efficacy of apixaban in prevention of haemorrhagic complications in treatment of deep vein thromboses with endovascular techniques

Sukovatykh B.S.¹, Sereditskiy A.V.², Muradyan V.F.², Azarov A.M.², Sukovatykh M.B.¹, Khachatryan A.R.², Lapinas A.A.²

1) Department of General Surgery, Kursk State Medical University of the Ministry of Public Health of the Russian Federation, Kursk,
2) Department of X-ray Surgical Methods of Diagnosis and Treatment, Orel Regional Clinical Hospital, Orel, Russia

Purpose. This study was undertaken to investigate efficacy of apixaban in prevention of haemorrhagic complications during treatment of proximal thromboses of deep veins of the lower extremities using endovascular techniques.

Patients and methods. We retrospectively studied the results of treating a total of 50 patients presenting with deep vein thromboses at late stages of the pathological process. The patients were subdivided into 2 statistically homogeneous groups. Group One was composed of 30 patients undergoing treatment consisting in a combination of catheter-guided thrombolysis with urokinase and percutaneous mechanical thrombectomy, with rivaroxaban used for prolonged anticoagulation therapy. Group Two comprised 20 patients subjected to similar endovascular treatment with additional venous stenting. Prolonged 6-month anticoagulation therapy was carried out with apixaban. The results of treatment were assessed after 12 months by means of control ultrasonographic and clinical examination in order to determine the degree of restoration of the lumen of deep veins and severity of venous outflow impairments.

Results. After 1 year, in Group One patients there was no evidence of impaired venous outflow in 40% of patients, with a mild degree revealed in 40%, moderate degree in 13.3%, and severe degree in 6.7% of patients. In Group Two patients, there were no symptoms of venous insufficiency in 83.4%, with a mild degree revealed in 16.6%. Neither moderate nor severe impairments of venous outflow were observed. In Group One, manifestations of haemorrhagic syndrome on the background of taking rivaroxaban were noted to occur in 10% of patients and in Group Two on the background of taking apixaban also in 10% of patients.

Conclusion. The use of apixaban in patients with proximal thromboses of deep veins of lower limbs on the background of treatment by endovascular techniques proved effective and safe.

KEY WORDS: proximal thrombosis, deep veins, lower extremities, percutaneous endovascular thromboextraction, regional thrombolysis with urokinase, venous stenting, rivaroxaban, apixaban.

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