Feasibility of Anticoagulation using Low Molecular‑weight Heparin during Catheter-directed Thrombolysis for Lower Extremity Deep Venous Thrombosis

Abstract

Background: The optimal anticoagulant scheme during catheter-directed thrombolysis (CDT) for deep venous thrombosis (DVT) remains unknown. The present study is performed to evaluate the effectiveness and safety of anticoagulation therapy using low molecular‑weight heparin (LMWH) during CDT for DVT.Methods: The clinical data of DVT patients underwent CDT during the past 6 years were retrospectively collected and reviewed. According to LMWH dose, patients were divided into therapeutic-dose anticoagulation (TPDA) group and sub therapeutic-dose anticoagulation (sub-TPDA) group.Results: A total of 61 patients involving 61 limbs were comprised. Acute and subacute DVT were identified in 39 (63.9%) and 22 (36.1%) patients, respectively. Thrombosis involving iliac vein was identified in 34 (55.7%) patients. Inferior vena cava filter placement was performed in 38 (62.3%) patients. Intraoperatively, adjunctive balloon, stent and thrombectomy were provided for 9 (14.8%), 4 (6.6%) and 1 (1.6%) patients, respectively. Twenty (32.8%) patients accepted TPDA therapy, while 41 (67.2%) patients were administrated with sub-TPDA therapy. Median urokinase infusion rates was 2.5 (0.83 to 5) x 104 U/h. Median infusion duration time was 4 (2 to 14) days, and median urokinase dose infused was 240 (60 to 1080) x 104 U. During CDT, 5 (8.2%) cases of minor bleeding were observed, and blood transfusion was not required. No major bleeding, symptomatic pulmonary embolism or death occurred. Complete (>90%) and partial thrombolysis (50~90%) were achieved in 56 (91.8%) patients. In comparison with sub-TPDA group, TPDA group exhibited no significant difference in baseline characteristics, clinical improvement, thrombolysis results and complications.Conclusions: Anticoagulation therapy using low molecular‑weight heparin during CDT for DVT is effective and safe. In comparison with sub-therapeutic-dose anticoagulation, therapeutic-dose did not improve the thrombolytic effect or increase the rate of complication.