Outcomes of endovascular venous stenting in patients on direct oral anticoagulants and antiplatelet therapy at a tertiary referral center.

Abstract: Introduction Endovenous revascularization is the standard in the management of acute thrombotic, chronic post-thrombotic iliocaval or iliofemoral obstruction, and non-thrombotic iliac vein lesions (NIVL). The purpose of this study is to describe our single-center experience of post-procedure anticoagulation and antiplatelet regimens used following endovenous revascularization for a variety of venous occlusive conditions. Methods We conducted a retrospective analysis of 100 consecutive patients who underwent endovenous stenting for iliocaval or iliofemoral obstruction from January 1, 2014 to April 30, 2018. Patients treated with direct oral anticoagulants, warfarin, or low molecular weight heparin (LMWH) with or without antiplatelet therapy were identified. Demographic, procedural, patency, and follow up data were collected. Stent patency was evaluated using duplex Doppler ultrasound or contrast venography. Results Seventy-one of 100 patients were treated with direct oral anticoagulant therapy (DOAC). Sixteen (23%) were lost to follow up, leaving 55 (77%) available for analysis. Mean follow up was 14 months (range 1-43) with 32 (58%) patients followed 12 months or longer. Primary, primary assisted, and secondary assisted patency rates were 87%, 97%, 98% respectively at 12 months. In the non-DOAC group (patients treated with warfarin or LMWH), these rates were 87%, 93%, and 95% respectively, at 12 months. Antiplatelet therapy including clopidogrel, aspirin, or both was used in 53 of 55 patients in the DOAC cohort and 18 of 19 patients in the non-DOAC group. Conclusion Our single center retrospective analysis demonstrates acceptable primary patency rates when using DOAC therapy compared to those treated with warfarin/LMWH.