Effectiveness of preliminary heparinotherapy in treatment of patients with deep venous thromboses with apixaban

To compare the efficacy and safety of apixaban in the treatment of distal and proximal deep vein thrombosis of the lower extremities without and in combination with initial heparin therapy. Materials and methods. The results of treatment of 120 patients with deep vein thrombosis of the lower extremities were studied. The first group consisted of patients with distal, located below the knee joint gap, and the second-with proximal thrombosis above the knee joint gap. The first group was divided into subgroups A and B, and the second-into subgroups C and D, 30 people each. In subgroups A and B, initial therapy with heparin was not carried out, but oral administration of apixaban was immediately prescribed in subgroup A for 3 months, and in subgroup B for 6 months. In subgroups B and D, patients received initial therapy with non-fractional heparin until the intensity of pain and edema syndromes decreased, and then in subgroup B - three months, and in subgroup D - six months of apixaban. The duration of heparin therapy in subgroup B averaged 2 days, and in subgroup D - 5. During treatment, the frequency of manifestations of hemorrhagic syndrome was recorded. The results of treatment were assessed after 1 year according to the degree of deep vein patency and the severity of impaired venous outflow according to the Villalt scale. Research results. Hemorrhagic syndrome developed in 14 (11.7%) patients, 7 cases in each group. It manifested itself as cutaneous, oropharyngeal and ocular hemorrhages, which were small in volume and were corrected by a decrease in the dose of apixaban. In the first group, complete restoration of the lumen of the veins was recorded in 45 (75%), and in the second group - in 19 (31.7%), partial, respectively, in 15 (25%) and 33 (55%) patients. There were no cases of occlusion in the first group, and in the second it developed in 8 (13.3%) patients. In the first group, 45 (75%) had no manifestations of chronic venous insufficiency after 1 year, and in the second group - 19 (31.7%). Moderate and severe impairment developed in the first group in 4 (6.7%) patients, and in the second group - in 25 (41.7%) patients. In patients with distal thrombosis, there were no significant differences between subgroups A and B, and in patients with proximal thrombosis, initial heparin therapy in subgroup D reduced the incidence of venous outflow impairment by 1.3 times compared with subgroup C. Conclusion. Initial heparin therapy improves treatment outcomes in patients with proximal deep vein thrombosis.