Comparative efficacy and safety of enoxaparin followed by warfarin and rivaroxaban monotherapy in the treatment of venous thrombosis in patients after intracardiac catheter interventions


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Abstract

Aim: to compare two anticoagulant therapy (ACT) regimens in the treatment of venous thrombosis (VT) in patients after catheter interventions - electrophysiological studies (EFIs) and ablations: enoxaparin followed by warfarin, and rivaroxaban monotherapy. Materials and methods. The study included patients from 18 years and older with heart rhythm disorders and planned catheter ablation. When parietal venous thrombosis (VT) were detected at the femoral vein puncture site, all patients were randomly assigned to two treatment groups. In group I enoxaparin 1 mg/kg was prescribed every 12 hours with switching to warfarin after 7 days with maintenance of the target INR values (2.0-3.0). In group II rivaroxaban therapy was started at a dose of 15 mg twise/day for 21 days with a further transition to a dose of 20 mg/day. The total period of observation and treatment of patients was at least 3 months. Results. 408 patients were observed, 42 (10.3%) patients with parietal VT were divided into two treatment groups. In group I (n=16) complete lysis of VT was noted by the 7th day of treatment in 7 (58.3%) patients, however this scheme was associated with a greater risk of complications (р=0.003) at the puncture site in the form of arteriovenous fistulae (n=1; 8.3%) and intermuscular hematomas (n=4; 25%). In group II (n=26), no complications were noted, the lysis time of VT was on average 21 days (n=18; 69.2%). Complete lysis of VT was noted in both groups at the time of the control observation point (3rd month). Conclusion. The efficiency of the two VT treatment regimens was comparable. Enoxaparin therapy is associated with a high risk of local complications, namely intermuscular hematomas (n=4; 25%) and arteriovenous fistulas (n=1; 8.3%). Rivaroxaban monotherapy is safer (p=0.003); in Group II none of the patients had any complications.

About the authors

A I Loginova

National Medical Research Center of Cardiology

Email: dr.loginova.a@gmail.com
врач-кардиолог, аспирант отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России; ORCID: 0000-0002-2865-0799 Moscow, Russia

E S Kropacheva

National Medical Research Center of Cardiology

к.м.н., с.н.с. отд. клинических проблем атеротромбоза НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

E B Maykov

National Medical Research Center of Cardiology

д.м.н., с.н.с. лаб. интервенционных методов диагностики и лечения нарушений ритма сердца отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

T V Balakhonova

National Medical Research Center of Cardiology

д.м.н., проф., г.н.с. отд. ультразвуковой диагностики НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

S P Golitsyn

National Medical Research Center of Cardiology

д.м.н., проф., руководитель отд. клинической электрофизиологии и рентгенохирургических методов лечения нарушений ритма сердца НИИ клинической кардиологии им. А.Л. Мясникова ФГБУ «НМИЦ кардиологии» Минздрава России Moscow, Russia

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