Anticoagulation plus antiplatelet therapy versus anticoagulation alone following iliac vein stent implantation in acute and subacute deep vein thrombosis: A multicenter study with propensity score matching.

Background: Iliac vein stenting is an effective treatment for iliac venous stenosis after percutaneous mechanical thrombectomy. Nevertheless, while some researchers have investigated medical therapy following iliac vein stenting, no consensus has been reached to date.
Objectives: To evaluate the effectiveness and safety of anticoagulation plus antiplatelet therapy following iliac vein stent implantation in patients with acute and subacute iliofemoral deep vein thrombosis (DVT).
Materials and Methods: This retrospective study comprised 234 patients: 167 patients in Group 1 with a mean age of 64.3 ± 13.5 years received anticoagulants alone, and 67 patients in Group 2 with a mean age of 60.7 ± 15.4 years received anticoagulation plus antiplatelet therapy. All patients received technically successful percutaneous pharmacomechanical thrombectomy and iliac vein stent implantation, and 61 patients underwent additional catheter-directed thrombolysis. The two groups exhibited comparable demographics, comorbidities, DVT burdens, and procedural details. Through propensity score matching (PSM) analysis, 62 pairs of patients from Group 1 and Group 2 were matched.
Results: During a follow-up period of 33.7 ± 16.5 months, the cumulative primary patency rates were 95.1 %, 89.7 % and 88.3 % at one, three and five years in Group 1 compared to 98.8 %, 98.5 % and 98.5 % in Group 2 for the entire cohort (p = 0.042); in the PSM analysis, the rates were 91.9 %, 87.3 % and 87.3 % at one, three and five years in Group 1 versus 98.4 % at one, three and five years in Group 2 (p = 0.039). The cumulative bleeding-free rate was 98.2 % at one, three and five years in Group 1 versus 95.5 %, 93.8 % and 93.8 % at one, three and five years in Group 2 for the entire cohort (p = 0.089), and it was 98.4 % at one, three and five years in Group 1 versus 95.2 %, 93.3 % and 93.3 % (p = 0.156) at one, three and five years in Group 2 in the PSM analysis.
Conclusion: Anticoagulation plus antiplatelet therapy significantly improved stent patency, with a non-significant increase in the bleeding rate.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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