[The effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis prognosis].

Objective: To explore the effect of anticoagulant thrombolytic therapy on acute deep venous thrombosis (DVT) and the incidence and severity of post-thrombotic syndrome (PTS).

Method: A total of 111 patients (113 limbs) with central or mixed types of deep venous thrombosis admitted from March 2003 to November 2008 were analyzed. The patients were divided into 3 groups by different therapies: anticoagulant group (41 limbs), thrombolysis group (27 limbs), and catheter-directed thrombolysis group (45 limbs). In the follow-up, patients' swelling of lower extremity and recanalization of vein were found out by physical examination and venous ultrasound Duplex through following-up. The Villalta and VCSS marking scales were used in rating the incidence and severity of PTS, discussing treatments for acute phase as well as adjuvant treatment for chronic phase and the correlation between the incidence and severity of PTS.

Results: The average time of follow-up were (41 ± 19) months in anticoagulant group, (52 ± 11) months in thrombolysis group, and (26 ± 10) months in catheter-directed thrombolysis group. According to the consequences from Villalta and VCSS rating scales, the incidences of PTS in the three groups were 58.5% (24/41), 55.6% (15/27), and 35.6% (16/45), in which 20.8% (5/24), 3/15, and 1/16 were severe. The the catheter-directed thrombolysis group had a better consequence than the other two groups in reducing incidence and severity of PTS (P < 0.05). The differences of circumferences of lower extremities of all patients had obvious improvement compared to that before the treatments. For patients who were treated by catheter-directed thrombolysis, the thigh circumference difference and calf circumference difference were (0.5 ± 1.0) cm and (0.7 ± 1.0) cm, which were more obvious compared to other two groups (P < 0.05). Most patients had their external-iliac and common-femoral veins recanalized. Using anticoagulant pharmaceuticals and compression stockings can lead to a reduction in the incidence of PTS.

Conclusions: The incidences and symptoms of PTS and swelling of limbs can be significantly moderated by catheter-directed thrombolysis based on anticoagulating in the acute phase of DVT. Consequently, it would be the most efficient way in decreasing the occurrences of PTS and moderating the severities of PTS with the aids of regular anticoagulating and compression stockings.