Anticoagulation Management and Recurrent Thrombosis after Venous Stenting for Deep Vein Thrombosis and Post-thrombotic Syndrome.

Abstract

There are no evidence based recommendations for anticoagulation management after venous procedures. This study aimed to evaluate how anticoagulation was managed after venous stenting for deep vein thrombosis (DVT) and post-thrombotic syndrome (PTS). Patients who underwent venous stenting for DVT or PTS from May 2006 to November 2021 were screened for inclusion. The primary endpoint was post-interventional management of anticoagulation or antiplatelet therapy. Secondary endpoints were recurrent venous thromboembolism (VTE) and potential risk factors (e.g., thrombophilia and left iliac vein compression syndrome). All patients underwent thrombophilia tests for the study's purpose. Descriptive statistics were applied for anticoagulation management. Recurrent VTE free survival was estimated using Kaplan-Meier methods (log rank). Binary logistic regression was conducted to estimate risk factors for recurrent VTE. Seventy nine patients were included: 41 DVT and 38 PTS. Until the last follow up (median 250 weeks, interquartile range [IQR] 158, 439), anticoagulation was continued for 57 (72%) and stopped for 22 (28%) patients. Post-interventional recurrent VTE occurred in 30 (38%) patients (32% DVT [n = 13]; 45% PTS [n = 17]) after a median duration of 11 weeks (IQR 3, 129), of which 93% were in stent re-thrombosis. Primary patency was 62% (n = 49) and secondary patency 94% (n = 74). Most recurrent VTEs (87%) occurred during anticoagulant therapy. Anticoagulation was re-started in all five patients with recurrent VTE after cessation of anticoagulant therapy. Anticoagulant therapy remained stopped in the absence of recurrent VTE (n = 17). Thrombophilia seemed to be statistically significantly associated with increased recurrent VTE (odds ratio 3.02, 95% confidence interval 1.13 - 8.07; p = .027) and left iliac vein compression syndrome with decreased recurrent VTE (odds ratio 0.30, 95% confidence interval 0.10 - 0.90; p = .032). Significance was lost in multivariable analysis. Recurrent VTE occurred in 38% patients (32% DVT; 45% PTS), almost always (93%) in stent re-thrombosis. Although approximately a quarter of patients experienced VTE after cessation of anticoagulation, stent patency was restored in all cases. No risk factors for recurrent VTE were identified.