Microcirculation parameters in determining the prolonged treatment of «fragile» patients with recurrent deep vein thrombosis

Abstract

Introduction. The use of factor Xa inhibitors in deep vein thrombosis is effective and associated with lower hemorrhagic risk compared with low molecular weight heparins and warfarin. For «fragile» patients with increased tissue bleeding, the tactics are not prescribed in the recommendations. The possibility of using sulodexide in prolonged therapy has been noted. Aim. To determine the tactics of prolonged anticoagulant therapy of recurrent deep vein thrombosis in «fragile» patients using microcirculation parameters. Materials and methods. Microcirculation parameters were recorded using a 25 MHz high-frequency ultrasound Doppler sensor on the nail bed of the 1st finger of the upper limb. A 7 MHz sensor were used for control color duplex scan after 21 days and 2, 3, and 6 months of treatment. Based on the parameters of microcirculation and hemorrhagic risk, treatment tactics were changed, 44 patients with increased tissue bleeding after 3 months received rivaroxaban 10 mg per day, 14 patients with a hemorrhagic history received sulodexide 500 LSU 2 times a day for 3 months, then 250 LSU 2 times a day, 39 patients received the standard treatment regimen. Results. There were no hemorrhagic complications or relapses. Recanalization was faster with full-dose rivaroxoban therapy: Qam 0.638±0.22 / 1.258±0.32(0.06); slower when the dose was reduced: Qam 0.772±0.31/2.418± 0.57 (0.02) and the use of sulodexide Qam 0.725±0.44/1.258±0.32(0.06); after 6 months, there was practically no difference in the groups and full recanalization was achieved. Conclusion. A reduced dosage of rivaroxaban was effective in increased tissue bleeding. The use of sudodexide in patients with hemorrhagic history allowed to obtain a good result without new hemorrhagic complications and significant deviations in microcirculation parameters. Monitoring of the latter made it possible to change tactics in a timely manner and avoid hemorrhagic complications in patients with increased tissue bleeding and microcirculatory reactivity, which can be proposed for wider use in daily clinical practice.