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


CONCLUSIONS
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.
Sabeti
Schila
S
Department of Angiology, University of Vienna, Medical Faculty, Austria. schila.sabeti@akh-wien.ac.at
Schillinger
Martin
M
Mlekusch
Wolfgang
W
Haumer
Markus
M
Ahmadi
Ramazanali
R
Minar
Erich
E
D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D001367:Axillary Vein / Q000000981:diagnostic imaging*; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D010644:Phenprocoumon / Q000627:therapeutic use; D011186:Postphlebitic Syndrome / Q000139:chemically induced; D012189:Retrospective Studies; D013350:Subclavian Vein / Q000000981:diagnostic imaging*; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D014463:Ultrasonography; D034941:Upper Extremity; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use; D020246:Venous Thrombosis / Q000150:complications / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D006493:Heparin; D014568:Urokinase-Type Plasminogen Activator; D010644:Phenprocoumon