Laag Moleculaire Heparine superieur in de behandeling van DVTr?

Is long-term low molecular weight heparin better than oral anticoagulation in reducing post-thrombotic syndrome?

Patients with deep vein thrombosis treated with low molecular weight heparin show a lower rate of post-thrombotic syndrome than those treated with vitamin K antagonists, a study presented at the European Venous Forum in Ljubljana, Slovenia, has shown. After two years of follow-up, 45.7% of the patients in the vitamin K antagonists group had post-thrombotic syndrome vs. 25.3% of the patients treated with low molecular weight heparin. The results of a prospective, randomised study were presented by Marc A Cairols, Servei d’Angiologia i Cirurgia Vascular, Hospital Universitari de Bellvitge, Barcelona, Spain. “In the general population, deep vein thrombosis has an incidence of 160 cases per 100.000 inhabitants every year, with a mortality rate of 3.5%,” Cairols said. “In the acute phase, we need to avoid or reduce clot progression, and reduce complications such as pulmonary embolism. In the chronic period, we have to reduce recurrence of venous thromboembolism events, improve vein patency, preserve valve function, reduce the incidence of post-thrombotic syndrome and reduce vein hypertension.” Post-thrombotic syndrome, Cairols added, is the most incapacitating complication. “The diagnosis is clinical, the incidence approaches to 20–50% in the general population, even after a correct anticoagulation therapy, and between 5–10% of the patients will be CEAP 4–6.” The aim of the study was to assess whether, in patients with symptomatic lower limb deep vein thrombosis, long-term treatment with low molecular weight heparin is more effective in reducing the rate of post-thrombotic syndrome than vitamin K antagonists. A secondary aim was to assess whether valve incompetence after clot lysis is related to the incidence of post-thrombotic syndrome. From January 2008 to December 2010, 376 patients were seen in the emergency department during the period. Of them, 150 had a well established diagnosis of deep vein thrombosis. Mean age was 42 years, and 58% were men. The inclusion criteria were acute proximal deep vein thrombosis and diagnosed using ultrasound imaging. Cancer patients and those with an expected live survival less than two years were excluded. Patients were divided into two treatment groups. Group A included only patients receiving low molecular weight heparin from the beginning of the treatment. Group B included patients initially treated with low molecular weight heparin (5–7 days), replaced by an oral vitamin K antagonist a week later. Patients were randomly allocated with undisclosed envelops. Clinical follow-up were carried out every six months until two years with Villalta scale and duplex imaging. A Villalta score ≥10 and/or reflux lasting more than two seconds were considered diagnostic of significant post-thrombotic syndrome. In the overall population, there was a 19.3% incidence of post-thrombotic syndrome patients (62% minor and 38% moderate). In group A there were 38 patients with post-thrombotic syndrome vs. 17 in the low molecular weight heparin group (p<0.008). From 129 patients with valvular incompetence 46 had post-thrombotic syndrome after two year of follow-up. However, from the 21 with valvular competence nine showed post-thrombotic syndrome (p=0.34). Sixty six patients showed recanalisation, and 30 had post-thrombotic syndrome. In 84 there was no recanalisation and 25 had post-thrombotic syndrome. In conclusion, Cairols said, long-term low molecular weight heparin showed fewer incidences of post-thrombotic syndrome after two years of follow-up. However, neither valve incompetence nor rate of recanalisation were associated with the rate of post-thrombotic syndrome. http://www.cxvascular.com/vn-venous-news/vascular-news---venous-news/is-long-term-low-molecular-weight-heparin-better-than-oral-anticoagulation-in-reducing-post-thrombotic-syndrome Deze studie bevestigd onze eigen Klinische en Duplex resultaten en onderstreept onze behandelingskeuze voor LMWH in de behandeling van DVTr. Dr. Harry Spoelstra