Antithrombotics after Venous Stenting: Rather Different from Coronary Artery Stenting

Should the Antithrombotic/antiplatelet therapy following 10.0 by 60 mm stent implantation to the subclavian vein of a chronic kidney patient be the same as one following a 3.0 by 18 mm stent implantation to the second segment of the left anterior descending artery of this same patient? The daily practice of many interventional cardiologists performing these procedures says it should. However, this new consensus brings up completely deferent data that is worth looking into.

This is the first studyAn on this matter to gather evidence and the experience of interventionists in the venous territory.

Not only does the study look into several important issues, such as the use of anticoagulation, treatment duration, or patients that require a thrombophilia study, but also clearly states that there is no evidence on the role of antiplatelet agents in this context (which is the classic indication of interventional cardiologists mostly dedicated to coronary arteries).

Read also: Is TAVR Durable Beyond 5 Years?

The following are the consensus statements:

1. Anticoagulation is preferable to antiplatelet antiaggregation during the first 6 to 12 months after venous stent implantation following venous stenting for reasons other than the May-Turner syndrome.
2. There was no consensus recommending antiaggregation for life after venous stenting for reasons other than the May-Turner syndrome.
3. Low molecular weight heparin is the preferred anticoagulation treatment during the first 2 to 6 weeks after venous stenting.  
4. Screening for thrombophilia is essential after discontinuation of post thrombolysis and stenting anticoagulation in the context of a first episode of deep vein thrombosis.
5. After deep vein thrombosis with thrombolysis and iliac vein stenting, anticoagulation can be discontinued between months 6 to 12, as long as thrombophilia screening resulted negative, it was the first deep vein thrombosis, and the eco doppler shows no complication with the stent.
6. In patients with multiple vein thrombosis episodes and iliac stenting, anticoagulation should be for life.
7. There was no consensus on whether there is a benefit to adding antiplatelet antiaggregation after successful stenting in a patient with a history of multiple vein thrombosis and post thrombolytic syndrome.

Título original: Antithrombotic Therapy Following Venous Stenting: International Delphi Consensus.

Reference: Kristijonas Milinis et al. Eur J Vasc Endovasc Surg (2018), Article in press.

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.