Quality of life after catheter-directed thrombolysis and standard anticoagulation for iliofemoral deep-vein thrombosis

• Main Authors: Jithin Jagan Sebastian, M K Ayyappan, Pranay Pawar, Kapil Mathur, Radhakrishnan Raju, Naveen Rajendra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2019-01-01
• Series: Indian Journal of Vascular and Endovascular Surgery
• Subjects: catheter-directed thrombolysis; ileo-femoral deep-vein thrombosis; postthrombotic syndrome; quality of life
• Online Access: http://www.indjvascsurg.org/article.asp?issn=0972-0820;year=2019;volume=6;issue=4;spage=274;epage=277;aulast=Sebastian
• ISSN: 0972-0820; 2394-0999

Introduction: Acute ilio-femoral deep-vein thrombosis (IFDVT) is associated with the morbidity of postthrombotic syndrome (PTS). There are many younger patients presenting with IFDVT in India. Not much is known of the incidence of PTS in these patients and the quality of life (QOL) after treatment with catheter-directed thrombolysis (CDT) or standard anticoagulation in these patients. Materials and Methods: A prospective, nonrandomized, case–control study was conducted on patients who presented with acute, primary IFDVT (<14 days) to a tertiary care hospital. Patients with iliac and femoral deep vein thrombosis, confirmed by computed tomography venogram, were studied. PTS was assessed by the Villalta score. Disease-specific QOL was measured by Venous Insufficiency Epidemiological and Economic Study (VEINES)-QOL/Symptoms and health-related QOL by the EuroQOL (EQ)-5D questionnaires. Results: A total of 100 patients with acute IFDVT were followed up for a mean of 33 months. Villalta score and QOL scores for 49 CDT patients and 51 patients managed conservatively were calculated. Demographics were comparable between the groups. PTS developed in 29% of patients (18% vs. 39%, P = 0.035). The QOL calculated by VEINES-Sym/QOL (mean 74.29 vs. 70.14, P = 0.006) and EQ-5D (mean 0.50 vs. 1.76, P = 0.004) showed significant difference. Both scores were significant for PTS versus no PTS (P ≤ 0.001). Absolute risk reduction between the groups was 20.8% and the number needed to treat was one in five patients. Conclusion: CDT reduces the incidence of PTS and improves the health-related and disease-specific QOL in a younger population of patients with acute IFDVT, compared to standard treatment with anticoagulation alone.