Venous stenting after deep venous thrombosis and antithrombotic therapy: A systematic review

Introduction Over the last years venous stent placement after deep venous thrombosis (DVT) in the iliofemoral veins has gained more attention. The majority of studies evaluating the safety and efficacy of this intervention are of poor methodological quality and the association with antithrombotic therapy has not been studied explicitly. We performed a systematic review to summarize the available literature on antithrombotic management in relation to the safety and efficacy of venous stenting. Methods We performed a Medline search to identify studies that addressed anticoagulation and/or antiplatelet treatment options after venous stenting in patients with a prior DVT in the iliofemoral area. We identified 192 articles and finally selected 14 articles for use in this review. Results In 86% (12/14) of the included studies anticoagulation was administered to all patients who underwent iliac venous stenting. In 33% of the studies patients received antiplatelet therapy consisting of aspirin and/or clopidogrel (4/12). The duration of antithrombotic treatment was not guided by the stenting procedure in 93% (13/14) of studies. The incidence of re-thrombosis in (sub) groups of only stented patients, ranged from 5% to 25%. Primary, assisted primary, and secondary patency rates 12 months after stent placement ranged from 54%, 72%, 83% respectively to 78%, 83%, 95% in (sub)groups of only stented patients. Rates of major bleedings during long term follow-up ranged from 0% to11%. Conclusion Antithrombotic therapy does not seem to influence any of the outcomes in patients with venous stenting after DVT: recurrent DVT, patency, post-thrombotic syndrome or restenosis and bleeding.