Anticoagulant combined with antiplatelet therapy is associated with improved iliac vein stent patency following thrombolysis and thrombectomy of subacute iliofemoral deep vein thrombosis: A retrospective propensity score matching cohort study

BackgroundStent patency is a critical outcome after thrombolysis, thrombectomy and stenting of subacute thrombotic iliac vein lesions (TIVL) and there is currently no consensus regarding post-procedural antithrombotic therapy. This study aims to investigate the differences between anticoagulant combined with antiplatelet therapy (dual-pathway inhibitors therapy, DPI) and anticoagulant therapy alone (AC) in reducing the incidence of occlusion after stenting for subacute TIVL.MethodsA retrospective cohort study collected data from patients treated with stent insertion for iliac vein lesion (IVL) after thrombolysis and thrombectomy from June 2018 to December 2022. 180 patients were included based on inclusion and exclusion criteria, and were divided into two groups based on their antithrombotic prophylaxis: the DPI group and the AC group. A 1:1 propensity score matching (PSM) was performed to balance confounding covariates between the groups. Risk factors for the primary stent patency were assessed with univariate and multivariate Cox regression. Kaplan-Meier analysis and log-rank tests were used to evaluate survival difference.ResultsAfter PSM, 45 patients were included in the DPI and in the AC groups, and baseline characteristics were comparable. Cox regression analysis indicated that DPI therapy was associated with better primary stent patency (HR = 0.363, 95% CI: 0.149∼0.881) (<i>p</i> = .025). Kaplan-Meier curves showed that the 2-years primary stent patency rate in DPI group was 84.4% (38/45), while the rate in AC group was 62.2% (28/45), with a significant difference in survival between the groups (log-rank test <i>p</i> = .017). Only minor bleeding occurred in both cohorts, and event rates did not differ significantly between groups [(9/45) versus (5/45), <i>p</i> = .384].ConclusionFor patients with subacute TIVL undergoing stent insertion, anticoagulant combined with antiplatelet therapy was associated with better stent patency compared to anticoagulant alone. This novel finding may have implications for optimizing medical management following venous stenting after endovascular therapy of subacute iliofemoral deep vein thrombosis.