Imperial College London, London, UK.
London Postgraduate School of Surgery and Imperial College London, London, UK.
Eur J Vasc Endovasc Surg. 2018 Apr;55(4):537-544. doi: 10.1016/j.ejvs.2018.01.007. Epub 2018 Feb 12.
OBJECTIVE/BACKGROUND: Deep venous stenting is increasingly used in the treatment of deep venous obstruction; however, there is currently no consensus regarding post-procedural antithrombotic therapy. The aim of the present study was to determine the most commonly used antithrombotic regimens and facilitate global consensus.
An electronic survey containing three clinical scenarios on venous stenting for non-thrombotic iliac vein lesions, acute deep vein thrombosis (DVT), and post-thrombotic syndrome was distributed to five societies whose members included vascular surgeons, interventional radiologists, and haematologists. The results of the initial survey (phase 1) were used to produce seven consensus statements, which were distributed to the respondents for evaluation in the second round (phase 2), along with the results of phase 1. Consensus was defined a priori as endorsement or rejection of a statement by ≥ 67% of respondents.
Phase 1 was completed by 106 experts, who practiced in 78 venous stenting centres in 28 countries. Sixty-one respondents (58% response rate) completed phase 2. Five of seven statements met the consensus criteria. Anticoagulation was the preferred treatment during the first 6-12 months following venous stenting for a compressive iliac vein lesion. Low molecular weight heparin was the antithrombotic agent of choice during the first 2-6 weeks. Lifelong anticoagulation was recommended after multiple DVTs. Discontinuation of anticoagulation after 6-12 months was advised following venous stenting for a single acute DVT. No agreement was reached regarding the role of long-term antiplatelet therapy.
Consensus existed amongst respondents regarding anticoagulant therapy following venous stenting. At present, there is no consensus regarding the role of antiplatelet agents in this context.
目的/背景：深静脉支架置入术在深静脉阻塞的治疗中应用日益广泛；然而，目前对于术后抗栓治疗尚未达成共识。本研究旨在确定最常用的抗栓方案并促进全球共识。
一项包含三个静脉支架置入术治疗非血栓性髂静脉病变、急性深静脉血栓形成（DVT）和血栓后综合征的临床场景的电子调查，分发给五个学会，这些学会的成员包括血管外科医生、介入放射科医生和血液科医生。首轮调查（第 1 阶段）的结果用于生成 7 项共识声明，并分发给受访者在第二轮（第 2 阶段）进行评估，同时还提供了第 1 阶段的结果。共识预先定义为至少 67%的受访者对某项声明的支持或反对。
第 1 阶段有 106 名专家完成，他们在 28 个国家的 78 个静脉支架置入中心执业。61 名受访者（58%的回复率）完成了第 2 阶段。有 5 项声明符合共识标准。对于压迫性髂静脉病变，静脉支架置入术后的前 6-12 个月内，抗凝治疗是首选。在最初的 2-6 周内，低分子肝素是首选的抗栓药物。在发生多次 DVT 后，建议长期抗凝。对于单一急性 DVT 后的静脉支架置入术，建议在 6-12 个月后停止抗凝。对于长期抗血小板治疗的作用，未达成共识。
受访者对于静脉支架置入术后的抗凝治疗存在共识。目前，对于这种情况下抗血小板药物的作用，尚未达成共识。
