RESUMO
BACKGROUND: The optimal anticoagulant following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) is unknown. METHODS: From the Swiss Venous Stent registry, an ongoing prospective cohort study, we performed a subgroup analysis of patients with acute IFDVT who underwent catheter-based early thrombus removal followed by nitinol stent placement. Duplex ultrasound and Villalta scores were used to determine patency rates and incidence of the post-thrombotic syndrome (PTS) in patients treated with either rivaroxaban (nâ¯=â¯73) or a vitamin K-antagonist (VKA; nâ¯=â¯38) for a minimum duration of 3â¯months. RESULTS: Mean follow-up duration was 24⯱â¯19â¯months (range 3 to 77â¯months). Anticoagulation therapy was time-limited (3 to 12â¯months) in 56% of patients (47% in the rivaroxaban group and 58% in the VKA group, pâ¯=â¯0.26), with shorter mean duration of anticoagulation in the rivaroxaban group (180⯱â¯98â¯days versus 284⯱â¯199â¯days, pâ¯=â¯0.01). Overall, primary and secondary patency rates at 24â¯months were 82% (95%CI, 71-89%) and 95% (95%CI, 87-98%), respectively, with no difference between the rivaroxaban (87% [95%CI, 76-94%] and 95% [95%CI, 85-98%]) and the VKA group (72% [95%CI, 52-86%] and 94% [95%CI, 78-99%]; pâ¯>â¯0.10 for both). Overall, 86 (86%) patients were free from PTS at latest follow-up, with no difference between the rivaroxaban and the VKA groups (57 [85%] versus 29 [88%]; pâ¯=â¯0.76). Two major bleeding complications (1 in each group) occurred in the peri-interventional period, without any major bleeding thereafter. CONCLUSIONS: In patients with acute IFDVT treated with catheter-based early thrombus removal and venous stent placement, the effectiveness and safety of rivaroxaban and VKA appear to be similar. CLINICAL TRIAL REGISTRATION: The study is registered on the National Institutes of Health website (ClinicalTrials.gov; identifier NCT02433054).