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Fabrication of Small Caliber Stent-grafts Using Electrospinning and Balloon Expandable Bare Metal Stents
Published on: October 26, 2016
[Antithrombotic therapy after venous stenting]
1Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia.
Insights
Anticoagulant therapy is recommended after venous stenting, with duration varying by clinical situation. Low-molecular-weight heparins are preferred initially, but prolonged disaggregant use remains debated. Individualized treatment is crucial.
Area of Science:
- Vascular Surgery
- Hematology
- Pharmacology
Background:
- Venous stenting requires effective antithrombotic therapy to prevent complications.
- Optimal antithrombotic strategies, including duration and drug choice, remain debated.
- Existing literature provides varied recommendations for anticoagulant and disaggregant use.
Purpose of the Study:
- To review and synthesize current literature on antithrombotic therapy post-venous stenting.
- To analyze the findings of the first International Delphi Consensus on this topic.
- To establish evidence-based guidelines for antithrombotic management in various venous obstructive lesions.
Main Methods:
- Comprehensive literature review of antithrombotic therapy after venous stenting.
- Analysis of data from the International Delphi Consensus involving 106 experts from 78 centers worldwide.
- Evaluation of specific clinical scenarios including May-Thurner syndrome and post-thrombotic syndrome.
Main Results:
- Anticoagulant therapy is preferred for 6-12 months in non-thrombotic iliac vein lesions.
- Low-molecular-weight heparins are recommended for the initial 2-6 weeks post-stenting.
- Life-long anticoagulation is advised after multiple deep vein thromboses; discontinuation after 6-12 months is indicated for single deep vein thrombosis episodes.
Conclusions:
- Anticoagulant therapy is the preferred approach following venous stenting.
- Treatment duration and drug selection should be individualized based on clinical context.
- The role of disaggregant therapy in combination with anticoagulants requires further investigation and consensus.
Abstract:
Presented herein is a literature review considering the problems of using antithrombotic therapy after venous stenting. Described herein are the literature data according to which the authors give preference to anticoagulant therapy (low-molecular-weight heparins, vitamin K antagonists, direct oral anticoagulants). This is followed by considering the problems of duration of treatment depending on various clinical situations. According to the presented data, the problem of prescribing disaggregants in a combination with anticoagulants after stenting of veins remains disputable, finding however many supporters. Analysed in the article are the results of the first International Delphi Consensus dedicated to antithrombotic therapy after venous stenting. Participating in the study were 106 independent experts practicing stenting in 78 centres of 28 countries of the world. Nonthrombotic iliac vein lesions, having appeared as May-Thurner syndrome due to extravasal compression and residual obstruction after thrombolysis, as well as the presence of postthrombotic syndrome were the main 'scenarios' for our study. The study resulted in working out provisions considering the policy of antithrombotic therapy in various obstructive lesions of deep veins. According to the presented data, anticoagulant therapy is preferable during 6-12 months after stenting in nonthrombotic iliac vein lesions. Low-molecular-weight heparins appear to be a method of choice in treatment during the first 2-6 weeks. Life-long administration of anticoagulants is recommended after multiple deep vein thromboses. Discontinuation of anticoagulants after 6-12 months is indicated after venous stenting in one episode of deep vein thrombosis. No consensus was achieved regarding the role of prolonged disaggregant therapy. Underlined in the article is the importance of a meticulous individual approach to choosing optimal policy of antithrombotic therapy and determining therapeutic policy together with a haematologist.
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