One-Year Outcomes of Dual Versus Single Antithrombotic Therapy Following Iliac Vein Stenting for Acute Iliofemoral DVT

The optimal post-stent antithrombotic regimen for acute iliofemoral deep vein thrombosis (DVT) in the setting of iliac vein compression syndrome is debated, with uncertainty surrounding the trade-off between preventing thrombotic events and minimizing bleeding risk. This single-center retrospective study compared rivaroxaban monotherapy (n = 84) versus combined rivaroxaban and aspirin therapy (n = 84) in 168 patients undergoing iliac vein stenting for acute iliofemoral DVT. Over a 1-year follow-up, combined therapy was associated with significantly lower rates of thrombus recurrence (7.1% vs 18.1%, <i>P</i> = .035) and in-stent thrombosis (2.4% vs 13.3%, <i>P</i> = .008) compared with anticoagulation alone. Clinically relevant bleeding events were infrequent and comparable between both groups. The reduction in thrombotic outcomes with dual therapy remained significant after propensity score matching adjusted for baseline characteristics. These results suggest that a strategy combining anticoagulant and antiplatelet therapy after iliac vein stenting may more effectively prevent thrombus recurrence and stent-related thrombosis without a significant increase in bleeding risk, offering a potential tailored approach for this patient population.