Association of dual-pathway antithrombotic therapy with primary patency after iliofemoral venous stenting: a...

The optimal antithrombotic strategy after iliofemoral venous stenting remains uncertain.

This study aimed to evaluate the association of dual-pathway antithrombotic therapy with primary patency after iliofemoral venous stenting.

This ambispective, multicenter observational study included consecutive patients who underwent successful iliofemoral venous stent implantation between 2019 and 2024. Patients were categorized according to their postoperative antithrombotic regimen into dual-pathway antithrombotic therapy (anticoagulation plus antiplatelet therapy [AC+APT]) and anticoagulation (AC) alone groups. The primary outcome was primary stent patency. Cox regression was used to identify independent predictors of loss of patency.

A total of 247 patients were included, with 145 receiving AC+APT and 102 receiving AC alone. During a median follow-up of 24 months (IQR, 15-38 months), the overall primary patency rate was 91.1%. Primary patency did not differ significantly between the AC+APT and AC groups in the overall cohort (log-rank P = 1.00). However, in the post-thrombotic syndrome subgroup, AC alone was associated with a higher risk of patency loss compared with AC+APT (hazard ratio, 3.31; 95% CI, 1.02-10.74; P = .047).

Primary patency after iliofemoral venous stenting was similarly high with dual-pathway antithrombotic therapy and AC alone. An exploratory analysis suggested a possible association between AC+APT and improved patency in patients with post-thrombotic syndrome. Adequately powered randomized trials with longer follow-up are needed to confirm this finding and assess long-term safety.