Comparing Thrombectomy, Anticoagulants for Post-Thrombotic Syndrome After Deep Vein Thrombosis

Compared with anticoagulant therapy, mechanical thrombectomy treatment of iliofemoral deep vein thrombosis (DVT) reduced the incidence of post-thrombotic syndrome over 12 months, reported a study in the Journal of Vascular Surgery-Venous and Lymphatic Disorders.

“[Mechanical thrombectomy] treatment of iliofemoral DVT was associated with significantly lower Villalta scores and reduced incidence of PTS through 12 months compared with treatment using [anticoagulant therapy],” wrote the researchers, led by Steven Abramowitz, MD, from the MedStar Washington Hospital Center in Washington, DC.

Researchers enrolled a total of 164 matched patient pairs who either received anticoagulation in the ATTRACT trial or mechanical thrombectomy in the ClotTriever Outcomes registry. Logistic regression was used to estimate the likelihood of post-thrombotic syndrome at 12 months.

The mechanical thrombectomy group had lower incidences of post-thrombotic syndrome at both six and 12 months at 19% and 46% compared with the anticoagulation group at 46% and 38%, respectively (both P<.001).

After adjusting for baseline Villalta scores, the authors estimated patients in the anticoagulation group had significantly higher risk of experiencing any post-thrombotic syndrome (odds ratio [OR], 3.1; 95% CI, 1.5-6.2; P=.002) and moderate to severe post-thrombotic syndrome (OR, 3.1; 95% CI, 1.1-8.4; P=.027) at 12 months.

Mean Villalta scores were also lower at 30 days (3.3 vs 6.3), six months (2.5 vs 5.5), and 12 months (2.6 vs 4.9) with mechanical thrombectomy versus anticoagulation (all P<.001).

The authors noted the study was limited by potential bias introduced from comparing different studies with potentially different factors that could not be identified or controlled for; although, the report stated that the exclusion criteria were designed to minimize this effect. Additionally, the anticoagulation regimens used in each study were “presumably distinct” due to differing availability.

“Results from currently enrolling clinical trials will further clarify the role of these therapies in the prevention of post thrombotic syndrome following an acute [DVT} event,” the researchers wrote.

Reference

Abramowitz S, Shaikh A, Mojibian H, et al. Comparison of anticoagulation versus mechanical thrombectomy for the treatment of iliofemoral deep vein thrombosis. J Vasc Surg Venous Lymphat Disord. 2024. doi.org/10.1016/j.jvsv.2024.101825