Antithrombotic Therapy After Venous Interventions: AJR Expert Panel Narrative Review

Sirish Kishore, Minhaj S. Khaja, Bartley Thornburg, Aditya M. Sharma, M. Grace Knuttinen, Fadi Shamoun, Simon Mantha, Kush R. Desai, Akhilesh K. Sista, Stephen A. Black, Gerard J. O’Sullivan, John A. Kaufman, Lawrence V. Hofmann, Ronald S. Winokur

Research output: Contribution to journalReview articlepeer-review

1 Scopus citations

Abstract

Interventions for thrombotic and nonthrombotic venous disorders have increased with technical advances and more trained venous specialists. Antithrombotic therapy is essential to clinical and procedural success; however, postprocedural therapeutic regimens exhibit significant heterogeneity due to limited prospective randomized data and incomplete mechanistic understanding of the critical factors driving long-term patency. Postinterventional antithrombotic therapy for thrombotic venous disorders should adhere to existing venous thromboembolism management guidelines, which include 3–6 months of therapeutic anticoagulation at minimum and consideration of extended therapy in patients with higher risk of thrombosis because of procedural or patient factors. The added benefit of antiplatelet agents in the acute and intermediate period is unknown, having shown improved long-term stent patency in some retrospective studies. Dual- and/or triple-agent therapy should be limited based on individual risks of thrombosis and bleeding. The treatment of nonthrombotic disorders is more heterogeneous, though patients with limited flow, extensive stent material, or underlying prothrombotic states such as malignancy or chronic inflammation may benefit from single-agent or multiagent antithrombotic therapy. However, the agent, dose, and duration of therapy remain indeterminate. Future prospective studies are warranted to improve patient risk stratification and standardize postprocedural antithrombotic therapy in patients receiving venous interventions.

Original languageEnglish (US)
Pages (from-to)175-187
Number of pages13
JournalAmerican Journal of Roentgenology
Volume219
Issue number2
DOIs
StatePublished - Aug 2022

Keywords

  • angioplasty
  • anticoagulation
  • antiplatelet
  • antithrombotic
  • deep vein thrombosis
  • guidelines
  • iliocaval
  • iliofemoral
  • portal vein
  • postthrombotic syndrome
  • splanchnic vein thrombosis
  • stent
  • thrombosis
  • vein
  • vena cava
  • venous

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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