Comparison of Anticoagulation Regimens Following Stent Placement for Nonthrombotic Lower Extremity Venous Disease.

Abstract: Purpose To determine whether sub-therapeutic anticoagulation regimens are non-inferior to therapeutic anticoagulation regimens following stent placement for nonthrombotic lower extremity venous disease. Materials and Methods Fifty-one consecutive patients (88% female, mean age 44 years) who underwent stent placement for nonthrombotic lower extremity venous disease between 2002-2016 were retrospectively identified. Patients were divided into two cohorts: those who received post-procedural prophylactic enoxaparin or no anticoagulation (sub-therapeutic), and those who received therapeutic doses of post-procedural anticoagulation with enoxaparin, warfarin, and/or rivaroxaban (therapeutic). Baseline demographic characteristics, procedure characteristics, and outcomes were compared between the two groups using Student's t, Fisher’s exact, and χ2 tests. The sub-therapeutic and therapeutic anticoagulation groups did not differ significantly on baseline demographic characteristics (e.g. sex, race, age) or procedure characteristics (e.g. number of stents placed, stent brand, stent diameter, etc.). Results Mean clinical follow-up time was 4.4 years (range 0 to 16.3 years). There were no thrombotic adverse effects or luminal obstructions due to in-stent restenosis in either group. There were 5 minor bleeding adverse effects in the therapeutic group and 0 bleeding adverse effects in the sub-therapeutic group (p = 0.051). There were no statistically significant differences in subjective symptom improvement (p = 0.75). Conclusion In this retrospective cohort, sub-therapeutic and therapeutic anticoagulation regimens produced equivalent outcomes in terms of adverse effect rates, reintervention rates, and symptomatic improvement, suggesting that therapeutic doses of anticoagulation do not improve outcomes when compared to sub-therapeutic anticoagulation regimens following nonthrombotic venous stent placement.