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Role of Target Specific Oral Anticoagulation after revascularization of subclavian vein thrombosis
Jeontaik J. Kwon, MD, MSc, Paul DiMuzio, MD, Babak Abai, MD, Dawn Salvatore, MD, Taki Galanis, MD, Geno Merli, MD, Luis Eraso, MD.
Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Background:
The purpose of this study is to review the efficacy of Target Specific Oral Anticoagulants (TSOAC) versus warfarin for post-surgical anticoagulation in patient with primary subclavian vein thrombosis. Rivaroxaban, a factor Xa inhibitor, was the first TSOAC approved by the FDA in 2011 for the treatment and prevention of deep vein thrombosis. However, the efficacy and safety of TSOAC for prevention of recurrent deep vein thrombosis after revascularization of upper extremity compression syndromes is largely unknown.
Methods
Twenty-two patients who underwent surgical intervention for Paget-Schroetter syndrome from 2009 to 2015 at our institution were retrospectively reviewed. Standard protocol with short term anticoagulation treatment was given after combination of surgical intervention including catheter directed lysis, balloon angioplasty, mechanical thrombectomy, and first rib resection. Fourteen patients (64%) received warfarin and 8 patients (36%) received rivaroxaban for post-operative anticoagulation regimen and followed up with ultrasound.
Results
There was 100% success in maintaining patency at the time of initial follow-up ultrasound in both groups. Average age in warfarin and rivaroxaban was 32 years (range 17-59 years) and 28 years (range 15-47 years), respectively. Mean creatinine level was 1.0 g/dL (warfarin) and 0.9 g/dL (rivaroxaban). In warfarin group, the mean therapeutic period was 150 days (range 70-484 days) with mean follow-up interval of 96 days (range 35-176 days) for ultrasound examination. In rivaroxaban group, mean therapeutic period was 112 days (range, 91-132 days) with follow-up interval of 114 days (range, 67-175 days). There was no major bleeding complication associated with medication during therapeutic period in both groups. Each group had one immediate post-operative complication of hemothorax. Mean post-operative length of stay was 2.6+/-1.4 days in warfarin group and 2.5+/-0.7 days in rivaroxaban group.
Conclusion
Selective usage of a TSOAC (rivaroxaban) in post-operative patients with Paget-Schroetter syndrome offer an alternative anticoagulation regimen with equal efficacy to traditional low molecular weight heparin and vitamin K inhibitor regimen.
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