Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting

Masayuki Endo, Younes Jahangiri, Masahiro Horikawa, John Kaufman, Ryan C. Schenning, Kenneth Kolbeck, Robert Barton, Yasufumi Ohuchi, Keng Wei Liang, Khashayar Farsad

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Purpose: To examine the effectiveness of antithrombotic medications to prevent venous stent malfunction for iliocaval occlusive disease. Materials and Methods: A retrospective analysis was performed on 62 patients who underwent technically successful endovascular iliocaval stent placement between May 2008 and April 2017. Clinical records were reviewed for demographic information, procedure details, post-stenting antithrombotic prophylaxis and stent patency on follow-up. Stent malfunction was defined as > 50% stenosis or occlusion at follow-up. Risk factors for stent malfunction were assessed with univariable and multiple Cox proportional hazard models. Results: The median follow-up period was 11.6 months (range 0.1–76.4). Overall primary and secondary cumulative patency rates at 12 months were 70.0% and 92.4%, respectively. After stent placement, 97% of patients received anticoagulation with warfarin, enoxaparin or a factor Xa inhibitor. In addition, 61% received antiplatelet prophylaxis with aspirin, clopidogrel or a combination. In multiple Cox regression analysis, post-stenting antiplatelet use remained significantly associated with primary stent patency (HR = 0.28, P = 0.022). Conclusion: After iliocaval venous stenting, stent patency was best predicted by concomitant antiplatelet and anticoagulation therapy rather than anticoagulation alone. This novel finding warrants further research underlying mechanisms leading to venous stent thrombosis, and has implications for optimal medical management after venous stenting.

Original languageEnglish (US)
Pages (from-to)1691-1698
Number of pages8
JournalCardioVascular and Interventional Radiology
Volume41
Issue number11
DOIs
StatePublished - Nov 1 2018

Fingerprint

Stents
Therapeutics
clopidogrel
Enoxaparin
Warfarin
Proportional Hazards Models
Venous Thrombosis
Aspirin
Pathologic Constriction
Regression Analysis
Demography
Research

Keywords

  • Antiplatelet
  • Antithrombotic prophylaxis
  • Iliocaval
  • Patency
  • Venous stent

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting. / Endo, Masayuki; Jahangiri, Younes; Horikawa, Masahiro; Kaufman, John; Schenning, Ryan C.; Kolbeck, Kenneth; Barton, Robert; Ohuchi, Yasufumi; Liang, Keng Wei; Farsad, Khashayar.

In: CardioVascular and Interventional Radiology, Vol. 41, No. 11, 01.11.2018, p. 1691-1698.

Research output: Contribution to journalArticle

Endo, Masayuki ; Jahangiri, Younes ; Horikawa, Masahiro ; Kaufman, John ; Schenning, Ryan C. ; Kolbeck, Kenneth ; Barton, Robert ; Ohuchi, Yasufumi ; Liang, Keng Wei ; Farsad, Khashayar. / Antiplatelet Therapy is Associated with Stent Patency After Iliocaval Venous Stenting. In: CardioVascular and Interventional Radiology. 2018 ; Vol. 41, No. 11. pp. 1691-1698.
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AB - Purpose: To examine the effectiveness of antithrombotic medications to prevent venous stent malfunction for iliocaval occlusive disease. Materials and Methods: A retrospective analysis was performed on 62 patients who underwent technically successful endovascular iliocaval stent placement between May 2008 and April 2017. Clinical records were reviewed for demographic information, procedure details, post-stenting antithrombotic prophylaxis and stent patency on follow-up. Stent malfunction was defined as > 50% stenosis or occlusion at follow-up. Risk factors for stent malfunction were assessed with univariable and multiple Cox proportional hazard models. Results: The median follow-up period was 11.6 months (range 0.1–76.4). Overall primary and secondary cumulative patency rates at 12 months were 70.0% and 92.4%, respectively. After stent placement, 97% of patients received anticoagulation with warfarin, enoxaparin or a factor Xa inhibitor. In addition, 61% received antiplatelet prophylaxis with aspirin, clopidogrel or a combination. In multiple Cox regression analysis, post-stenting antiplatelet use remained significantly associated with primary stent patency (HR = 0.28, P = 0.022). Conclusion: After iliocaval venous stenting, stent patency was best predicted by concomitant antiplatelet and anticoagulation therapy rather than anticoagulation alone. This novel finding warrants further research underlying mechanisms leading to venous stent thrombosis, and has implications for optimal medical management after venous stenting.

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