Cessation of anticoagulation therapy following endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis

Abstract

Summary. Background: The optimal duration of anticoagulation therapy (AT) following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) with stent placement is unknown. Theoretically, resolving the underlying obstructive iliac vein lesion by a stent may eliminate the main trigger for recurrence, the post-thrombotic syndrome (PTS), and the need for extended-duration AT. Patients and methods: From 113 patients with acute IFDVT who underwent endovascular thrombus removal and stent placement, we compared patency rates and clinical outcomes between 58 patients on limited-duration AT (3–12 month) and 55 patients on extended-duration AT (> 12 months). Results: Mean follow-up duration was 26 ± 18 (range 3–77) months; it was 24 ± 18 (range 3–69) months after cessation of AT in the limited-duration AT group. In comparison to patients with extended-duration AT, patients with limited-duration AT were younger (38 versus 54 years; p < 0.001), more often female (74 % versus 49 %; p = 0.01), and had less often prior venous thromboembolism (VTE) (9 % versus 35 %; p = 0.001). May-Thurner syndrome was more frequent in the limited-duration AT group (66 % versus 38 %; p = 0.004). Overall, primary and secondary patency rates at 24 months were 80 % (95 % CI, 70–87 %) and 95 % (95 % CI, 88–98 %), respectively, with no difference between the groups. Overall, 17 (15 %) patients developed recurrent VTE, of which 14 (82 %) events were thrombotic stent occlusions, and 13 (76 %) events occurred during AT. In the limited-duration AT group, 98 % patients were free from the PTS at two years with a VTE recurrence rate of 3.5 per 100 patient years after cessation of AT. Conclusions: In selected patients with acute IFDVT and patent venous stent, particularly in younger and otherwise healthy patients with May-Thurner syndrome, it appears to be safe to discontinue AT 3–12 months after endovascular treatment. Clinical Trial Registration: The study is registered on the National Institutes of Health website (ClinicalTrials.gov; identifier NCT02433054).

Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome

“…Compared with data on VTE recurrence rates in patients with acute iliofemoral DVT who underwent thrombus removal and venous stent placement, we observed an almost twofold increased VTE recurrence rate in PTS patients (7.1 vs. 13.0 events per 100 patient-years). 25,26 A possible explanation for this observation is that acute iliofemoral DVT patients often have preserved femoral leg inflow veins, and less often require stents below the inguinal ligament. For patients with PTS, the use of antiplatelet agents in addition to anticoagulants appears plausible to address the risk of ST in the first 6 months after stent recanalization.…”

Multidisciplinary staged management of iliofemoral venous thrombosis caused by huge uterine fibroid: a case report

“…Nonetheless it has been reported that in selected patients with acute iliofemoral deep vein thrombosis and patent venous stent, particularly younger and otherwise healthy patients with May-Thurner syndrome, anticoagulation therapy can be safely discontinued 3 to 12 months after endovascular treatment. 7 Our patient received anticoagulation for 1 year after surgery.…”

Update on early thrombus removal for iliofemoral deep vein thrombosis

“…Control group/Comparison group Follow-up PTS no difference in patency and clinical outcome after 3-12 months vs longer duration with AC in stented patients after CDT, as well as no difference between vitamin K-antagonists and rivaroxaban for the first 3 months period of treatment (41,42). Many reviews have been published.…”