Antithrombotic therapies for patients with acute iliofemoral deep vein thrombosis following endovenous recanalization: A single-center study and literature review

Objectives There is no consensus regarding the optimal antithrombotic therapy following endovenous recanalization. We aim to assess the effectiveness of anticoagulant, antiplatelet, or combination therapy to provide evidence-based recommendations for antithrombotic therapy following interventional procedures. Methods An Institutional Review Board approved, retrospective study of patients presented to our facility with iliofemoral venous thrombosis requiring thrombolysis and/or thrombectomy with or without venous angioplasty/stenting between January 1, 2010 and April 1, 2023. Incidence of vein or stent patency, thrombosis, and bleeding were considered primary endpoints and were compared between patients on anticoagulant, antiplatelet, or combination therapies at each post-interventional surveillance, up to five visits. Results The cohort yielded 128 patients, including 116 adults and 12 minors. We identified a notable trend in the post-recanalization medical routines of patients: those initially prescribed combination therapy post-procedure eventually transitioned to either exclusive anticoagulant or antiplatelet therapy. The initial combination antithrombotic therapy was associated with trends towards higher vein patency (59% vs 47% with anticoagulant vs 25% antiplatelet, p = .3), less recurrent vein and stent thrombosis (46% vs 54% with anticoagulants vs 100% antiplatelet, p = .10), and overall low major bleeding complications (3.2% vs 6.8% anticoagulant, p = .5) at first follow-up compared to those on anticoagulant or antiplatelet regimens alone. Conclusion Although the optimal post-interventional antithrombotic therapy remains uncertain, combination therapy was associated with trends towards higher vein patency and lower recurrent thrombosis, with low overall major bleeding complications at the first follow-up visit following interventions. Future studies encompassing larger and more diverse populations are essential to corroborate the findings presented in this report and offer valuable insights for optimizing the management of patients with this condition.