Pharmaco Mechanical Thrombolysis Associated With Anticoagulation Compared With Anticoagulation in the Acute Phase of Very Symptomatic Proximal Venous Thrombosis of the Lower Limbs.

Patients with acute iliofemoral thrombosis will be included in the study after consent. They will be randomized to pharmaco-mechanical thrombolysis combined with anticoagulant therapy with direct oral anticoagulant versus direct anticoagulant therapy alone. They will be monitored, and patients in the anticoagulation-only group may undergo stenting angioplasty in the chronic phase if they present a moderate post-thrombotic syndrome or venous claudication. At the end of 30 months, a medico-economic analysis will be carried out.

Inclusion criteria

• Patients who agreed to participate in the study and gave oral consent.
• Patient affiliated to a social security scheme
• Iliac and/or common femoral venous thrombosis
• Recent thrombosis less than or equal to 14 days since qualifying imaging or less than or equal to 21 days since onset of symptoms

And at least 1 of the following criteria:

• Visual analog scale greater than or equal to 5 and/or
• Venous claudication and/or
• Increase in thigh circumference greater than or equal to 5% compared with contralateral thigh.

Exclusion criteria

• Patients with superficial femoral or popliteal venous thrombosis without involvement of the common femoral or iliac veins.
• Patients with isolated thrombosis of the inferior vena cava, without extension to the iliac veins.
• Thrombosis of inferior vena cava proximal to the renal veins.
• Minors, pregnant women, adults under guardianship.
• Chronic renal failure with creatinine clearance below 30ml/min according to Cockroft.
• Ischaemic phlebitis: proximal venous thrombosis associated with limb ischemia and impaired arterial flow.