Effect of thrombophilia on clinical outcomes of chronic post-thrombotic patients after iliofemoral stenting with nitinol venous stents

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) Vol. 9; no. 4; pp. 888 - 894
• Main Authors: Gwozdz, Adam M., Doyle, Andrew J., Hunt, Beverley J., Tincknell, Laura G., Jackson, Nick, Saha, Prakash, Breen, Karen A., Smith, Alberto, Cohen, Ander, Black, Stephen A.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2021
• Subjects: Adult; Alloys; Anticoagulants - therapeutic use; Antiphospholipid syndrome; Deep vein thrombosis; Female; Femoral Vein - surgery; Humans; Iliac Vein - surgery; Male; Middle Aged; Post-thrombotic syndrome; Postthrombotic Syndrome - complications; Postthrombotic Syndrome - surgery; Prosthesis Design; Reoperation; Retrospective Studies; Stents; Thrombophilia; Thrombophilia - complications; Treatment Outcome; Vascular Patency; Venous stent; Thrombophilia; Deep vein thrombosis; Venous stent; Post-thrombotic syndrome; Antiphospholipid syndrome
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2020.09.013

Thrombophilia is a prothrombotic condition that increases the risk of venous thromboembolism. It is unclear whether the presence of thrombophilia alters the clinical outcomes after deep venous stenting. The aim of the present study was to examine the relationship between thrombophilia and outcomes after stenting for post-thrombotic syndrome. Consecutive patients (2012-2017) receiving a nitinol venous stent for chronic post-thrombotic venous occlusive disease with a minimum of 18 months of follow-up in one center using the same anticoagulation protocol were included. The clinical history and thrombophilia testing results were reviewed. The outcomes were stent patency, which was assessed using duplex ultrasonography at 24 hours, 2 and 6 weeks, 3 months, 6 months, and annually thereafter; and reinterventions, which were performed when the stent diameter was <50% or occluded. Of the 136 patients who had undergone intervention, 55 (40%) had had a provoked deep vein thrombosis (DVT) and 81 (60%) had had an unprovoked DVT and had therefore undergone thrombophilia testing. Of the 81 patients, 38 (47%) had had either inherited (n = 19; 50%) or acquired (n = 19; 50%) thrombophilia. Of the 136 patients who had undergone stenting, 68 had required reintervention (50%) during follow-up to maintain stent patency. Of the 55 patients with a provoked DVT, 29 (53%) had required reintervention. Of the 81 patients with an unprovoked DVT, 39 (48%) had required reintervention (P = .420). Of the 38 patients with unprovoked DVT and thrombophilia, 17 (45%) had required reintervention. Of the 43 patients with unprovoked DVT and no thrombophilia, 22 (51%) had required reintervention (P = .766). The cumulative patency rate was 80% for patients with provoked DVT and 88% for those with unprovoked DVT (P = .193). The presence of thrombophilia was not associated with patency loss (92% cumulative patency for patients with thrombophilia and 84% for patients without thrombophilia; P = .307). Using our anticoagulation protocol, patients with and without thrombophilia had similar clinical outcomes after deep venous stenting and should not be excluded from iliofemoral venous stenting. We found no significant differences in outcomes in conjunction with appropriate postoperative anticoagulation therapy.