Rivaroxaban in the treatment of upper extremity deep vein thrombosis: A single-center experience and review of the literature. Issue 181 (September 2019) - Schastlivtsev, Ilya
Abstract: Introduction: Direct oral anticoagulants (DOACs) have become widely used to treat patients with venous thromboembolism (VTE), but evidence about their use in the treatment of upper extremity deep vein thrombosis (UEDVT) is lacking. Objectives: To assess rivaroxaban's efficacy and safety in the treatment of UEDVT. Patients/methods: This was a single-center prospective observational study involving patients with their first UEDVT episode confirmed by duplex ultrasound scan. All patients initially received low-molecular-weight heparin for 1 to 2 days and then were switched to rivaroxaban for 3–6 months. The primary endpoint was any symptomatic episode of recurrent VTE. Results: Thirty patients were included in the study, and all patients were followed for 6 months. There were no episodes of recurrent symptomatic venous thromboembolism or asymptomatic UEDVT. No episode of major bleeding was observed. Clinically relevant non-major bleeding occurred in two patients (6.7%, 95% confidence interval [CI]: 1.9–21.4%) with uterine bleeding and large skin hemorrhage. Minor bleeding was observed in two patients (6.7%, 95% CI: 1.9–21.4%) presenting with nasal and gingival bleeding. Recanalization of the upper extremity deep veins was observed in all affected limbs at three months, and it persisted up to 6 months. The signs of upper limb post-thrombotic syndrome (PTS) were found in four patients (13.4%; 95% CI: 5.4–29.8%), and the mean modified Villalta score was 2.1 ± 1.9. Conclusion: Treatment of UEDVT with rivaroxaban, preceded by one to two days of LMWH, seems to be safe and effective. Highlights: There are no strong guidelines for the treatment of upper extremity deep vein thrombosis (UEDVT). Rivaroxaban appears to be effective and rather safe in the treatment of UEDVT. Treatment of UEDVT with rivaroxaban is associated with a low rate of post-thrombotic syndrome.