Treatment of subclavian–axillary vein thrombosis: long-term outcome of anticoagulation versus systemic thrombolysis

• Published in: Thrombosis research Vol. 108; no. 5; pp. 279 - 285
• Main Authors: Sabeti, Schila, Schillinger, Martin, Mlekusch, Wolfgang, Haumer, Markus, Ahmadi, Ramazanali, Minar, Erich
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Ltd 15.12.2002; Elsevier Science
• Subjects: Adult; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Axillary Vein - diagnostic imaging; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Female; Follow-Up Studies; Hemorrhage - chemically induced; Heparin - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Pharmacology. Drug treatments; Phenprocoumon - therapeutic use; Post-thrombotic syndrome; Postphlebitic Syndrome - chemically induced; Retrospective Studies; Subclavian; Subclavian Vein - diagnostic imaging; Thrombolysis; Thrombolytic Therapy - adverse effects; Thrombosis; Treatment Outcome; Ultrasonography; Upper Extremity; Urokinase-Type Plasminogen Activator - therapeutic use; Vein; Venous Thrombosis - complications; Venous Thrombosis - diagnostic imaging; Venous Thrombosis - drug therapy; Subclavian; Vein; Thrombosis; Thrombolysis; Post-thrombotic syndrome; Human; Oral administration; Subclaviar vein; Cardiovascular disease; Anticoagulant; Fibrinolysis; Venous disease; Vascular disease; Chemotherapy; Treatment; Deep vein; Comparative study
• ISSN: 0049-3848; 1879-2472
• DOI: 10.1016/S0049-3848(03)00093-8

Objective: To investigate long-term clinical and morphological outcome of patients with subclavian–axillary vein thrombosis treated with systemic thrombolysis compared to anticoagulation in a retrospective, nonrandomised study. Methods: We studied 95 consecutive inpatients with subclavian–axillary vein thrombosis treated either with systemic urokinase thrombolysis and subsequent oral anticoagulation ( n=33) or with anticoagulation only ( n=62). Anticoagulation was performed with heparin and phenprocoumon. Patients were followed for median 40 months (IQR 14 to 94) for symptomatic upper extremity post-thrombotic syndrome and for venous recanalisation by duplex ultrasound. Results: Primary technical success rate of the systemic thrombolysis was 88% ( n=29) with seven peri-intervention bleeding complications (21%). No complication was observed in patients with anticoagulation only ( p<0.0001). At the time of follow-up, duplex sonography showed a thrombotic subclavian vein in 40 of 83 patients (48%), but only 9 of 95 patients (10%) had a symptomatic upper extremity post-thrombotic syndrome. Patients with systemic thrombolysis exhibited a 60% adjusted reduced risk for a thrombotic subclavian vein at the time of follow-up compared to patients with anticoagulation only (95% CI: 0.2 to 0.9, p=0.03). However, the frequency of symptomatic post-thrombotic syndrome after thrombolysis and anticoagulation was similar (adjusted p=0.6). Conclusion: Systemic thrombolysis of subclavian–axillary vein thrombosis has an acceptable primary technical success rate and improves venous recanalisation rates compared to anticoagulation. However, the high rate of complications during thrombolysis and the lack of clinical benefit suggest that conservative treatment may be favoured.