To Evaluate The Efficacy And Risk Of Anticoagulation And Thrombolysis Treatment For Deep Venous Thrombosis Of Lower Limb

Objective:To evaluate the efficacy and risk of anticoagulation and thrombolysis treatment for deep venous thrombosis of lower limb.Method:This study was a single center, non randomized, retrospective study. From January 2009 to December 2015,673 cases (one side) of patients with vascular surgery in Ji’nan Central Hospital Affiliated to Shandong University were studied by the "deep vein thrombosis of lower limbs". Patients with lower extremity pain, swelling to the hospital, lower limb venous ultrasonography and or lower extremity anterograde angiography confirmed deep venous thrombosis treated in our department. During hospitalization, anticoagulation and or thrombolytic therapy (catheter directed thrombolysis or systemic thrombolysis) was administered. After discharge, continued anticoagulation (anticoagulation time reference to ACCP2008 guidelines) and lower extremity wear medical elastic stockings. Scheduled for regular follow-up after discharge, respectively in 1 month,3 months,6 months, and once every 6 months. 156 cases (23.2%) were successfully followed up for 2 years (and above),87 males and 69 females, aged 25-87 years old, the average age of 44 years, the hospitalization time 13-21 days, average 17 days, follow-up time 24-66 months, the average follow-up time is 37 months. In 156 patients,23 cases of iliac vein thrombosis,43 cases of femoral vein thrombosis,32 cases of iliofemoral venous thrombosis.58 cases of patients with venous thrombosis of calf muscle. We defined the iliac vein, femoral vein and iliac femoral venous thrombosis (combined or not combined with muscle venous thrombosis) as iliofemoral venous thrombosis (A),A1: inferior vena cava filter placement combined with catheter thrombolysis treatment A2: inferior vena cava filter placement combined with systemic thrombolytic therapy A3: anticoagulation alone. We defined the calf muscular venous thrombosis as group B. Bl:anticoagulation combined with thrombolysis treatment B2:anticoagulation alone. Analysis of all patients admitted to the hospital and discharged signs and symptoms, lower limb swelling elimination rate, bleeding risk, the rate of recurrence of deep venous thrombosis of lower extremity, the incidence of PTS, hospitalization period, etc.Result:Iliac femoral venous thrombosis after anticoagulant combined with thrombolytic treatment (Al group) the recent curative effect(swelling elimination rate) is obviously superior to systemic thrombolytic therapy (A2) and anticoagulant alone (A3) (P<0.05), the long-term incidence of Post-thrombotic syndrome incidence decreased(6.5%,28.6%,48.4%), but compared with the systemic thrombolytic therapy (A2) and anticoagulant therapy (A3) for relatively high bleeding complications(17.4%、14.3%、6.5%). Iliofemoral venous thrombosis after transcatheter thrombolytic therapy thrombolytic rate and recurrence of thrombosis (ipsilateral limbs) had a lower incidence of herpes(15.2%、28.6%,32.3%). PTS in calf muscular venous thrombosis after anticoagulant treatment system combined with thrombolytic therapy (B1) or anticoagulant therapy (B2) short-term curative effect and the post-thrombotic syndrome incidence of no significant difference(P>0.05). Iliaclemoral vein thrombosis were anticoagulation alone with a 7.4 fold risk compared with catheter directed thrombolysis. Conclusion:Lower extremity deep vein thrombosis is one of the common vascular disease, its etiology is complex, diverse. Our preliminary research results show for iliofemoral deep vein thrombosis, thrombolytic therapy, especially contact of catheter directed thrombolysis treatment not only can obtain obvious short-term curative effect and can reduce the PTS occurred recurrence rate and thrombosis rate.