Prolonged antithrombotic therapy (ATT) for lower extremity deep vein recanalization after previous thrombosis and the levels of C-reactive protein (CRP), D-dimer, homocysteine (HC) are still poorly understood.

OBJECTIVE

To study lower extremity deep vein recanalization in patients with proximal deep vein thrombosis (DVT) depending on ATT mode and serum levels of D-dimer, CRP and HC throughout a year.

MATERIAL AND METHODS

A prospective observational study included 227 patients divided into 3 groups. The first group included 70 patients who received vitamin K antagonists, the second group — 89 patients (direct oral anticoagulants), the third group — 68 patients (2.5-3.0-month course of warfarin therapy followed by administration of sulodexide).

RESULTS

Sulodexide therapy was accompanied by more significant iliac segment recanalization compared to vitamin K antagonists throughout 3 months. Prolonged direct oral anticoagulation and sulodexide for 3 months resulted more significant recanalization of the femoral segment by 14.6% and 18.4%, respectively, compared to vitamin K antagonists (p<0.05), 6-month therapy — by 20.5% and 13.5% (p<0.05), 12-month treatment — by 26.4% and 20.1% (p<0.05). Moreover, prolonged direct oral anticoagulation and sulodexide intake for 6 months were associated with better recanalization of the popliteal segment by 17.9% and 17.9%, respectively (p<0.05), 15-month therapy — by 15.6% and 12.8% (p<0.05) compared to vitamin K antagonists. Proximal recanalization following various ATT modes within a year was associated with serum levels of D-dimer, CRP and HC. A moderate or strong correlation between three markers and recanalization of iliac, femoral and popliteal segments after 3, 6 and 12 months was found.

CONCLUSION

Prolonged direct oral anticoagulation and sulodexide intake throughout 1 year in patients with previous proximal DVT are accompanied by early and better recanalization compared to vitamin K antagonist therapy. Reduced serum concentration of D-dimer, CRP and HC following ATT within a year correlates with recanalization of iliac, femoral and popliteal segments.