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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 6, November/December 2020

288

AFRICA

cm and venous flow was not limited; (2) partial recanalisation

if the length of the residual thrombus was

>

2 cm and venous

flow was slightly limited by the residual thrombus; (3) poor

recanalisation if the venous flow was prominently limited by the

residual thrombus. Interventional complications were classified

as minor (epistaxis, haematuria, skin ecchymosis) and major

complications (pulmonary embolus, intracranial haemorrhage

and major bleeding requiring blood transfusion).

All subjects underwent control duplex ultrasonography to

evaluate the patency of the relevant vein. Fibrinogen and

D-dimer levels were also re-measured. The percentage of vessel

patency and PTS development in the third month after PMT

were the primary outcome measures of this study.

Statistical analysis

All analyses were performed on SPSS v20 (IBM, Armonk, NY,

USA). The Shapiro–Wilk test was used for the normality check.

Data are presented as mean

±

standard deviation or median

(minimum–maximum) for continuous variables, with regard

to normality. Comparison of the pre- and post-thrombolysis

fibrinogen and D-dimer levels was performed with the paired

samples

t

-test. A two-sided

p

<

0.05 was accepted as statistically

significant.

Results

A total of 35 subjects (mean age 62

±

14 years, 57% male) with

lower-extremity DVT who underwent PMT were enrolled in

this study. Baseline characteristics of the study population are

presented in Table 1; 57% of the cases were acute DVT (

<

15

days) and 77% were in the femoropopliteal region. More than

half of the cases were unprovoked DVT.

Complete recanalisation was noted in 23 subjects (66%),

whereas recanalisationwasdefinedaspoor in two (6%).Aspiration

thrombectomy was performed as adjunctive technique to remove

the residual thrombus in two subjects with poor recanalisation

and in seven subjects with partial recanalisation after catheter-

directed thrombolysis (CDT). Two patients in the subacute DVT

group received stents for residual iliac vein stenosis.

The rate of minor complications was 14%. None of the

subjects experienced major complications such as intracranial

haemorrhage or pulmonary embolism. No mortality was

recorded during the three months of follow up. Control duplex

ultrasonography in the third month revealed that the target veins

were patent in all subjects. None of the subjects experienced PTS

during the three months of follow up.

Comparison of the subjects with acute and subacute DVT is

given in Table 2. Subjects with subacute DVT were older than

those with acute DVT (70

±

11 vs 56

±

14 years,

p

=

0.003).

There were no significant differences between subjects with

acute and subacute DVT in terms of risk factors for DVT,

aetiology, baseline and third-month fibrinogen and D-dimer

levels. Although the frequency of minor complications was

slightly higher in those with subacute DVT, the difference did

not reach statistical significance. The percentage of patients with

acute complete recanalisation was significantly higher in those

with acute DVT compared to those with subacute DVT (95 vs

27%,

p

<

0.001).

Discussion

This study aimed to investigate the role of PMT with low-dose

urokinase in patients with acute or subacute lower-extremity

DVT. Our findings demonstrate that PMT with low-dose

urokinase not only provided excellent vessel patency at three

months but also enabled safe thrombolysis due to the delivery of

lower-dose agents into the thrombus. Notably, with this method,

the acute complete recanalisation rate was significantly higher in

subjects with acute DVT than those with subacute DVT.

The main therapeutic goals for treating lower-extremity

DVT are the preservation of venous valve function and

prevention of pulmonary embolism and recurrent DVT.

Systemic anticoagulation with low-molecular weight heparin

or unfractionated heparin followed by warfarin or new oral

Table 1. Demographic features and clinical characteristics

of the study population (

n

=

35)

Demographic features

Number (%)

Age, years

62

±

14

Gender, male

20 (57)

Acute DVT

20 (57)

Location

Iliofemoral

8 (23)

Femoropopliteal

27 (77)

Diabetes

8 (23)

Dyslipidaemia

6 (17)

Smoking

13 (37)

Coronary artery disease

4 (11)

Aetiology

Major surgery

3 (9)

Obstetric conditions

4 (11)

Prolonged immobilisation

8 (23)

Unprovoked

20 (57)

Data are presented as mean

±

standard deviation for continuous variables and

frequency (%) for categorical variables.

Table 2. Comparison of subjects with acute and subacute DVT

Acute DVT

(n

=

20) n (%)

Subacute DVT

(n

=

15) n (%) p-value

Age, years

56

±

14

70

±

11

0.003

Gender, male

11 (55)

9 (60)

0.767

Dyslipidaemia

4 (20)

2 (13)

0.605

Diabetes

3 (15)

5 (33)

0.201

Coronary artery disease

2 (10)

2 (13)

0.759

Smoking

8 (40)

5 (33)

0.686

Aetiology

0.254

Major surgery

3 (15)

0 (0)

Obstetric conditions

3 (15)

1 (7)

Prolonged immobilisation

3 (15)

5 (33)

Unprovoked

11 (55)

9 (60)

Baseline fibrinogen (mg/dl)

472

±

114

425

±

99

0.214

Fibrinogen at 3rd month (mg/dl)

355

±

85

304

±

83

0.088

Baseline D-dimer (µg/ml)

3.4

±

1.2

4.2

±

2.4

0.287

D-dimer at 3rd month (µg/ml)

1.1

±

0.6

1.8

±

1.1

0.232

Complete recanalisation

19 (95)

4 (27)

<

0.001

Partial recanalisation

1 (5)

9 (60)

Poor recanalisation

0

2 (13)

Minor complications

1 (5)

4 (27)

0.070

Patency at 3rd month

20 (100)

15 (100)

>

0.999

Data are presented as mean

±

standard deviation for continuous variables and

frequency (%) for categorical variables.