Randomized controlled trials leading to the approval of apixaban and rivaroxaban for venous thromboembolism (VTE) did not include patients with upper extremity deep vein thrombosis (UE-DVT). We sought to evaluate the safety and effectiveness of rivaroxaban and apixaban for the treatment of acute UE-DVT. Consecutive patients with VTE enrolled into the Mayo Clinic VTE Registry, between March 1, 2013 and December 31, 2019, were followed prospectively. Clinical, demographic and imaging data were collected at the time of study recruitment. Patients with a diagnosis of acute UE-DVT who received rivaroxaban, apixaban, LMWH or warfarin were included. Recurrent VTE, major bleeding, clinical-relevant non-major bleeding (CRNMB), and death were assessed at 3-month intervals. During the study period, 210 patients with acute UE-DVT were included; 63 were treated with apixaban, 39 with rivaroxaban, and 108 with LWMH and/or warfarin. Overall 51% had catheter-associated UE-DVT, 60% had a diagnosis of malignancy, and 14% had concurrent pulmonary embolism. Malignancy was more common in patients treated with LMWH/warfarin (67% vs 52%, P = .03). At 3 months of follow up, one (0.9%) recurrent VTE occurred in a patient treated with LMWH/warfarin and one (1.0%) patient treated with apixaban or rivaroxaban (P = .97). Major bleeding occurred in three patients treated with LMWH/warfarin, and in none of those treated with apixaban or rivaroxaban (P = .09). Clinical-relevant non-major bleeding occurred in one patient (0.9%) treated with LWMH/warfarin and two patients (2.0%) treated with apixaban or rivaroxaban (P = .53). Treatment of UE-DVT with apixaban or rivaroxaban appears to be as safe and effective as LMWH/warfarin.

译文

:导致apixaban和rivaroxaban批准用于静脉血栓栓塞(VTE)的随机对照试验不包括上肢深静脉血栓形成(UE-DVT)的患者。我们试图评估利伐沙班和阿哌沙班治疗急性UE-DVT的安全性和有效性。在2013年3月1日至2019年12月31日期间,对进入Mayo诊所VTE注册中心的VTE连续患者进行了随访。在研究募集时收集了临床,人口统计学和影像学数据。包括接受利伐沙班,阿哌沙班,LMWH或华法林诊断为急性UE-DVT的患者。每三个月评估一次复发性VTE,大出血,临床相关的非大出血(CRNMB)和死亡。在研究期间,共纳入210例急性UE-DVT患者。 63例接受阿哌沙班治疗,39例接受利伐沙班治疗,108例接受LWMH和/或华法林治疗。总体上51%的患者有导管相关的UE-DVT,60%的患者被诊断为恶性肿瘤,而14%的患者同时发生了肺栓塞。在LMWH /华法林治疗的患者中,恶性肿瘤更为常见(67%vs 52%,P = 0.03)。在随访的3个月中,接受LMWH /华法林治疗的患者发生1例(0.9%)复发性VTE,接受阿哌沙班或利伐沙班治疗的患者1例(1.0%)发生(P = 0.97)。 LMWH /华法林治疗的三例患者发生大出血,而阿哌沙班或利伐沙班治疗的患者均未发生大出血(P = 0.009)。 LWMH /华法林治疗的一名患者(0.9%)和阿哌沙班或利伐沙班治疗的两名患者(2.0%)发生了与临床相关的非重大出血(P = 0.53)。用apixaban或rivaroxaban治疗UE-DVT似乎与LMWH /华法林一样安全有效。

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