Efficacy and Safety of Prophylactic Anticoagulation Versus Therapeutic Anticoagulation After Iliac Vein Stenting in Patients with a Nonthrombotic Iliac Vein Lesion.

BACKGROUND

The long-term patency of stents is notably high in patients undergoing stenting for nonthrombotic iliac vein lesions (NIVLs). Consequently, the postoperative antithrombotic strategy of employing therapeutic anticoagulation (TA) in these patients has been called into question. This study aims to compare the clinical outcomes of prophylactic versus TA at our center.

METHODS

In this single-institution retrospective study, a total of 155 patients with NIVLs who were prescribed either prophylactic or therapeutic doses of anticoagulation for a duration of 3 months following stent placement were enrolled. The outcomes assessed during follow-up included primary patency, bleeding events, mortality, the revised venous clinical severity score (r-VCSS) and symptom recurrence.

RESULTS

From October 2012 to April 2024, 82 patients received prophylactic anticoagulation (PA) and 73 TA, with a median follow-up period of 42 months. There was no significant difference between the PA group and the TA group in rates of primary patency (98.8% vs. 95.9%, P = 0.292, hazard ratio [HR] 0.317, 95% confidence interval [CI] 0.045 to 2.252), mortality (4.9% vs. 6.8%, P = 0.957, HR 1.035, 95% CI 0.277 to 3.866), as well as symptom recurrence (7.3% vs. 11.0%, P = 0.456, HR 0.670, 95% CI 0.235 to 1.914). In addition, the major bleeding events (0.0% vs. 1.4%, P = 0.471), the clinically relevant nonmajor bleeding events (3.7% vs. 8.2%, P = 0.385), total bleeding events (3.7% vs. 9.6%, P = 0.241), and the changes in the r-VCSS from baseline to 6 months postoperatively (5.00 [3.00, 6.00] vs. 5.00 [3.00, 6.00], P = 0.643) were also not significantly different in the 2 groups.

CONCLUSION

In patients with NIVLs, PA after iliac vein stenting exhibited similar clinical outcomes when compared with TA. This finding suggests that PA may be sufficient. Furthermore, the nonanticoagulation regimens merit further investigation.