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Tytuł:
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Comparing Safety and Efficacy of Rivaroxaban with Warfarin for Patients after Successful Stent Placement for Chronic Iliofemoral Occlusion: A Retrospective Single Institution Study.
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Autorzy:
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Zhang X; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China.
Huang J; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China.
Peng Z; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China.
Lu X; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China.
Yang X; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China.
Ye K; Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University, School of Medicine, Shanghai, China; Vascular Centre of Shanghai JiaoTong University, Shanghai, China. Electronic address: .
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Źródło:
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European journal of vascular and endovascular surgery : the official journal of the European Society for Vascular Surgery [Eur J Vasc Endovasc Surg] 2021 Mar; Vol. 61 (3), pp. 484-489. Date of Electronic Publication: 2020 Dec 31.
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Typ publikacji:
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Comparative Study; Journal Article; Research Support, Non-U.S. Gov't
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Język:
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English
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Imprint Name(s):
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Publication: 2002-: London : Elsevier
Original Publication: London, UK : W.B. Saunders Co. Ltd., c1995-
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MeSH Terms:
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Femoral Vein*/diagnostic imaging
Femoral Vein*/physiopathology
Iliac Vein*/diagnostic imaging
Iliac Vein*/physiopathology
Stents*
Anticoagulants/*therapeutic use
Endovascular Procedures/*instrumentation
Factor Xa Inhibitors/*therapeutic use
Postthrombotic Syndrome/*therapy
Rivaroxaban/*therapeutic use
Warfarin/*therapeutic use
Aged ; Anticoagulants/adverse effects ; Chronic Disease ; Databases, Factual ; Endovascular Procedures/adverse effects ; Factor Xa Inhibitors/adverse effects ; Female ; Hemorrhage/chemically induced ; Humans ; Male ; Middle Aged ; Postthrombotic Syndrome/diagnostic imaging ; Postthrombotic Syndrome/physiopathology ; Registries ; Retrospective Studies ; Rivaroxaban/adverse effects ; Time Factors ; Treatment Outcome ; Vascular Patency ; Warfarin/adverse effects
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Contributed Indexing:
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Keywords: Chronic iliofemoral occlusion; Endovascular stenting; Post-thrombotic syndrome; Rivaroxaban; Warfarin
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Substance Nomenclature:
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0 (Anticoagulants)
0 (Factor Xa Inhibitors)
5Q7ZVV76EI (Warfarin)
9NDF7JZ4M3 (Rivaroxaban)
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Entry Date(s):
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Date Created: 20210103 Date Completed: 20210412 Latest Revision: 20210412
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Update Code:
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20240105
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DOI:
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10.1016/j.ejvs.2020.11.050
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PMID:
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33388238
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Objective: The aim was to compare the safety and effectiveness of rivaroxaban and warfarin as anticoagulants for treating patients with post-thrombotic syndrome (PTS) with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting.
Methods: This single institution retrospective study analysed patients with PTS with chronic iliofemoral venous occlusion who were prescribed rivaroxaban or warfarin for one year after successfully undergoing iliofemoral venous stenting. The primary safety and efficacy endpoints were bleeding complication rate and primary patency rate at one year. Secondary outcomes included Villalta score, symptom recurrence rate, ulcer healing rate, and clinically driven target lesion revascularisation (CD-TLR) rate during follow up.
Results: From January 2016 to December 2017, 154 legs from 154 patients were included in this study (69 in rivaroxaban group and 85 in warfarin group). The groups were well matched for patient demographics, clinical characteristics, and procedural details. There was no significant difference between the rivaroxaban group and warfarin group in bleeding complication rate (10% vs. 16%, p = .23, hazard ratio [HR] 0.58, 95% confidence interval [CI] 0.25 - 1.37) at one year, as well as major bleeding complication rate (0% vs. 2%, p = .20, HR 0.16, 95% CI 0.01 - 2.61) and minor bleeding complication rate (10% vs. 14%, p = .40, HR 0.67, 95% CI 0.27 - 1.66). The primary patency rate was higher in the rivaroxaban group at one year (84% vs. 71%, p = .049, HR 0.50, 95% CI 0.26 - 0.96) and at two years (79% vs. 63%, p = .037, HR 0.52, 95% CI 0.29 - 0.93). At a mean follow up of 24 months (range 1 - 42 months), the rivaroxaban group had a significantly lower post-operative Villalta score (4.87 ± 3.51 vs. 6.88 ± 5.85, p = .010, t = 2.64, 95% CI 0.50 - 3.52), lower rate of symptom recurrence (4% vs. 32%, p < .001), lower CD-TLR rates (3% vs. 13%, p = .039), and higher ulcer healing rate (90% vs. 59%, p = .004) than the warfarin group.
Conclusion: For PTS patients with chronic iliofemoral venous occlusion undergoing iliofemoral venous stenting, rivaroxaban probably exhibited similar safety but superior efficacy to warfarin. However, further prospective control studies with large sample size are necessary to confirm the results.
(Copyright © 2020 European Society for Vascular Surgery. Published by Elsevier B.V. All rights reserved.)
Comment in: Eur J Vasc Endovasc Surg. 2021 Mar;61(3):490. (PMID: 33342657)
