Comparison of anticoagulation versus mechanical thrombectomy for the treatment of iliofemoral deep vein thrombosis.

To compare the comparative effects of treatment with contemporary mechanical thrombectomy or anticoagulation on Villalta scores and post thrombotic syndrome incidence through 12 months in iliofemoral deep vein thrombosis. Patients with deep vein thrombosis in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) randomized trial and the ClotTriever Outcomes (CLOUT) registry were included in this analysis. Both studies evaluated the effects of thrombus removal on the incidence of post thrombotic syndrome. Patients with bilateral deep vein thrombosis, isolated femoral-popliteal deep vein thrombosis, symptom duration >4 weeks, or incomplete case data for matching covariates were excluded. Propensity scores were used to match patients 1:1 that received anticoagulation (from ATTRACT) to those treated with mechanical thrombectomy (from CLOUT) using nearest neighbor matching on 9 baseline covariates, including age, body mass index, leg treated, provoked deep vein thrombosis, prior venous thromboembolism, race, sex, Villalta score, and symptom duration. Clinical outcomes, including Villalta score and post thrombotic syndrome, were assessed. Logistic regression was used to estimate the likelihood of developing post thrombotic syndrome at 12 months. A total of 164 pairs were matched, with no significant differences in baseline characteristics after matching. There were fewer patients with any post thrombotic syndrome at 6 months (19% vs 46%, p<.001) and 12 months (17% vs 38%, p<.001) in the mechanical thrombectomy treatment group. Modeling revealed that after adjusting for baseline Villalta scores, patients treated with anticoagulation had significantly higher odds of developing any post thrombotic syndrome (OR=3.1, 95% CI [1.5 to 6.2], p=.002) or moderate to severe post thrombotic syndrome (OR=3.1, 95% CI [1.1 to 8.4], p=.027) at 12 months compared with those treated with mechanical thrombectomy. Mean Villalta scores were lower through 12 months among those receiving mechanical thrombectomy vs anticoagulation (3.3 vs 6.3 at 30 days, 2.5 vs 5.5 at 6 months, and 2.6 vs 4.9 at 12 months, p<.001 for all). Mechanical thrombectomy treatment of iliofemoral deep vein thrombosis was associated with significantly lower Villalta scores and reduced incidence of post thrombotic syndrome through 12 months compared with treatment using anticoagulation. Results from currently enrolling clinical trials will further clarify the role of these therapies in the prevention of post thrombotic syndrome following an acute deep vein thrombosis event.

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