May-Thurner Syndrome
Conditions
Keywords
May-Thurner Syndrome, warfarin, rivaroxaban, stent implantation
Brief summary
The purpose of this study is to evaluate the efficacy and safety of rivaroxaban for the prevention of deep vein thrombosis in patients with left iliac vein compression treated with stent implantation.
Detailed description
Left Iliac Vein Compression Syndrome (LIVCS) is a disease of iliac vein stenosis/occlusion caused by chronic friction and compression of the left iliac vein by the right common iliac artery and lumbar vertebra. It is also called Cockett syndrome or May-Thurner syndrome. Recently, left iliac vein balloon dilatation with stent implantation have been used to treat patients with LIVCS, and have achieved good results. However, no matter the iliac vein stenosis or occlusion, interventional therapy can directly cause local trauma and intimal injury, which is a clear inducement of local thrombosis. Therefore, high intensity anticoagulation therapy is still needed to prevent secondary thrombosis in stent after left iliac vein balloon dilatation with stent implantation. At present, the postoperative anticoagulation regimen of these patients is early heparin anticoagulant therapy, and later warfarin anticoagulant therapy. However, due to the narrow therapeutic window of the drug, patients need to adjust the dosage according to coagulation function under the guidance of doctors. Rivaroxaban can simplify treatment, and is safe. Previous studies have shown that rivaroxaban is effective in preventing deep venous thrombosis after orthopaedic surgery. Rivaroxaban has also been shown to be safe and effective in anticoagulation therapy for patients with deep venous thrombosis and pulmonary embolism. However, Rivaroxaban lacks sufficient clinical data for adjuvant anticoagulation therapy after balloon dilatation with stent implantation. Therefore, this study should be carried out to provide the basis for LIVCS treatment guidelines and explore the clinical indications of rivaroxaban.
Interventions
DRUGRivaroxaban
Dose: 15mg twice daily for three weeks, then 20mg once daily until six months after the operation. Application: oral
DRUGWarfarin
Dose: 3mg for 5 days after the operation, later 0.75mg to 18mg depending on INR (2.0-3.0) until 6 months Duration: 6 months Frequency: once daily Application: oral
DRUGNadroparin
Dose: 1mg/kg Duration: 5 days after the operation Frequency: twice daily Application: subcutaneous
Sponsors
Sir Run Run Shaw Hospital
Huadong Hospital
Shanghai Zhongshan Hospital
Shanghai 5th People's Hospital
Yantai Yuhuangding Hospital
Anhui Provincial Hospital
Zhejiang Provincial People's Hospital
Zhejiang Hospital
Second Affiliated Hospital, School of Medicine, Zhejiang University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 75 Years
Healthy volunteers
No
Inclusion criteria
* Patients with thrombotic left iliac vein compression syndrome who underwent left iliac vein stent implantation
Exclusion criteria
* Age \< 18 years or age \> 75 years * With history of pelvic surgery, left iliac vein trauma and pelvic radiotherapy * With obvious contraindications for anticoagulation therapy * Allergic to iodine contrast agents in the past * With concomitant diseases that need high-intensity anticoagulation, and the anticoagulation intensity is clearly higher than that of the patients with iliac vein therapy alone * Active bleeding or potential bleeding risk * Pregnant or breastfeeding women * With pelvic tumors causing compression of left iliac vein, * With chronic venous insufficiency of lower extremities caused by K-T syndrome * With malignant tumors and life expectancy \< 1 year * Taking cytochrome P450 3A4(CYP-450 3A4) inhibitors or inducers
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| stent occlusion rate | 2 year after operation | Stent occlusion is defined as DS \> 50% for each modality with no procedure performed on the treated segment |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| All cause mortality | 1, 3, 6, 12, 18 and 24 months after operation | Percentage of participants with all deaths |
| anticoagulation raleted mortality | 1, 3, 6, 12, 18 and 24 months after operation | Percentage of participants with anticoagulation raleted deaths |
| Proportion of participants with stent displacement/fracture | 1, 3, 6, 12, 18 and 24 months after operation | Events will be assessed based on computed tomography (CT) or X ray |
| Quality of Life Change Scale Survey Results | 1, 3, 6, 12, 18 and 24 months after operation | Quality of life will be assessed by MOS item short-form health survey scale (SF-36). SF-36 includes eight subscales: physical functioning (PF, 10 items), role limitations due to physical health problems (RL-P, 4 items), bodily pain (BP, 2 items), general health (GH, 5 items), vitality (V, 4 items), social functioning (SF, 2 items), role limitations due to emotional problems (RL-E, 3 items) and mental health (MH, 5 items). The vitality sub-score assesses energy and fatigue, and ranges from 0 (worst) - 100 (best). |
| Proportion of participants with other vascular events | 1, 3, 6, 12, 18 and 24 months after operation | All vascular events (ST segment elevation myocardial infarction, non ST segment elevation myocardial infarction, acute coronary syndrome, unstable angina, ischemic stroke, transient ischemic attack, pulmonary embolism, non-central nervous system systemic embolism or vascular death) will be assessed based results/films/images of confirmatory testing, and/or case summaries. |
| Proportion of participants with thrombosis | 1, 3, 6, 12, 18 and 24 months after operation | — |
| Proportion of participants with hemorrhage | 1, 3, 6, 12, 18 and 24 months after operation | Including hemorrhagic stroke, gastrointestinal bleeding, hematuria, mucocutaneous hemorrhage and other visceral bleeding |
Countries
China
Contacts
Primary ContactLi Yin
Outcome results
None listed