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Incidence of Stent Thrombosis after Endovascular Treatment of Iliofemoral or Caval Veins in Patients with the Postthrombotic Syndrome.

Authors
  • Sebastian, Tim1
  • Spirk, David2
  • Engelberger, Rolf P3, 4
  • Dopheide, Jörn F5
  • Baumann, Frederic A1
  • Barco, Stefano6
  • Spescha, Rebecca1
  • Leeger, Claudia1
  • Kucher, Nils1
  • 1 Clinic for Angiology, University Hospital of Zurich, University of Zurich, Switzerland. , (Switzerland)
  • 2 Institute of Pharmacology, University of Bern, Bern, Switzerland. , (Switzerland)
  • 3 Medical Faculty, University of Bern, Bern, Switzerland. , (Switzerland)
  • 4 Division of Angiology, Cantonal Hospital Fribourg, Fribourg, Switzerland. , (Switzerland)
  • 5 Clinic for Angiology, Inselspital Bern, University of Bern, Bern, Switzerland. , (Switzerland)
  • 6 Center for Thrombosis and Hemostasis, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany. , (Germany)
Type
Published Article
Journal
Thrombosis and Haemostasis
Publisher
Georg Thieme Verlag KG
Publication Date
Dec 01, 2019
Volume
119
Issue
12
Pages
2064–2073
Identifiers
DOI: 10.1055/s-0039-1697955
PMID: 31659739
Source
Medline
Language
English
License
Unknown

Abstract

Patients with postthrombotic syndrome (PTS) treated with stents are at risk of stent thrombosis (ST). The incidence of ST in the presence and absence of anticoagulation therapy (AT) is unknown. Risk factors are not well understood. From the prospective Swiss Venous Stent registry, we conducted a subgroup analysis of 136 consecutive patients with PTS. Incidence of ST was estimated from duplex ultrasound or venography, and reported for the time on and off AT. Baseline, procedural, and follow-up data were evaluated to identify factors associated with ST. Median follow-up was 20 (interquartile range [IQR] 9-40) months. AT was stopped in 43 (32%) patients after 12 (IQR 6-14) months. Cumulative incidence of ST was 13.7% (95% confidence interval [CI] 7.8-19.6%) and 21.2% (95% CI 13.2-29.2%) during the first 6 and 36 months, respectively. The time-adjusted incidence rate was 11.2 (95% CI 7.7-16.2) events per 100 patient-years, 11.3 (95% CI 7.3-17.3) for the period on, and 11.2 (95% CI 5.3-23.6) for the period off AT. May-Thurner syndrome (MTS) was associated with decreased incidence of ST (hazard ratio [HR] 0.37, 95% CI 0.15-0.91), whereas age < 40 years (HR 2.26, 95% CI 1.03-4.94), stents below the common femoral vein (HR 3.03, 95% CI 1.28-7.19), and postthrombotic inflow veins (HR 2.92, 95% CI 1.36-6.25) were associated with increased incidence. The 6-month incidence of ST was considerably high. Beyond 6 months, consecutive annual incidence rates persisted at 4.1 and 3.4% per year thereafter. Patients with higher incidence of ST were younger, had stents below the common femoral vein, postthrombotic leg inflow veins, and less often MTS. Incidence rates for the period on and off AT must be interpreted with caution. The study is registered on the National Institutes of Health Web site (ClinicalTrials.gov; identifier NCT02433054). Georg Thieme Verlag KG Stuttgart · New York.

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