Rivaroxaban or vitamin-K antagonists following early endovascular thrombus removal and stent placement for acute iliofemoral deep vein thrombosis

Abstract

Background The optimal anticoagulant following catheter-based therapy of acute iliofemoral deep vein thrombosis (IFDVT) is unknown. Methods From the Swiss Venous Stent registry, an ongoing prospective cohort study, we performed a subgroup analysis of patients with acute IFDVT who underwent catheter-based early thrombus removal followed by nitinol stent placement. Duplex ultrasound and Villalta scores were used to determine patency rates and incidence of the post-thrombotic syndrome (PTS) in patients treated with either rivaroxaban (n = 73) or a vitamin K-antagonist (VKA; n = 38) for a minimum duration of 3 months. Results Mean follow-up duration was 24 ± 19 months (range 3 to 77 months). Anticoagulation therapy was time-limited (3 to 12 months) in 56% of patients (47% in the rivaroxaban group and 58% in the VKA group, p = 0.26), with shorter mean duration of anticoagulation in the rivaroxaban group (180 ± 98 days versus 284 ± 199 days, p = 0.01). Overall, primary and secondary patency rates at 24 months were 82% (95%CI, 71-89%) and 95% (95%CI, 87-98%), respectively, with no difference between the rivaroxaban (87% [95%CI, 76-94%] and 95% [95%CI, 85-98%]) and the VKA group (72% [95%CI, 52-86%] and 94% [95%CI, 78-99%]; p > 0.10 for both). Overall, 86 (86%) patients were free from PTS at latest follow-up, with no difference between the rivaroxaban and the VKA groups (57 [85%] versus 29 [88%]; p = 0.76). Two major bleeding complications (1 in each group) occurred in the peri-interventional period, without any major bleeding thereafter. Conclusions In patients with acute IFDVT treated with catheter-based early thrombus removal and venous stent placement, the effectiveness and safety of rivaroxaban and VKA appear to be similar.

Quality of anticoagulant therapy and the incidence of in‐stent thrombosis after venous stenting

“…Treatment with DOACs provides more stable anticoagulation and has been associated with improved recanalization and reduced incidence of postthrombotic syndrome 31,32 . It is therefore possible that DOACs might provide better protection against in‐stent thrombosis, although this has not yet been objectified and requires further clinical study 33 …”

Rivaroxaban after Thrombolysis in Acute Iliofemoral Venous Thrombosis: A Randomized, Open-labeled, Multicenter Trial

“…A single-center prospective registry study, recently published by Sebastian et al . 14 enrolled consecutive IFDVT patients who had nitinol stent placed after CDT and compared patients anticoagulated with rivaroxaban (n = 73) to those anticoagulated with VKA afterward (n = 38). There was no difference in the primary and the secondary patency between the rivaroxaban and the VKA group (87% vs. 72% and 85% vs. 94% at 24 months, respectively), and the rate of bleeding complications was also similar (8% vs. 13%).…”

Quality of Anticoagulant Therapy and the Incidence of In-Stent Thrombosis After Venous Stenting

“…31,32 It is therefore possible that DOACs might provide better protection against in-stent thrombosis, although this has not yet been objectified and requires further clinical study. 33 An important limitation is the small sample size of our study. This can be explained by the fact that venous stenting was and still is a relatively new treatment modality that is not yet performed on a large scale.…”