Ignatyev I M
Department of Cardiovascular and Endovascular Surgery, Kazan State Medical University of the RF Ministry of Public Health, Kazan, Russia.
Angiol Sosud Khir. 2019;25(3):183-187. doi: 10.33529/ANGID2019302.
Presented herein is a literature review considering the problems of using antithrombotic therapy after venous stenting. Described herein are the literature data according to which the authors give preference to anticoagulant therapy (low-molecular-weight heparins, vitamin K antagonists, direct oral anticoagulants). This is followed by considering the problems of duration of treatment depending on various clinical situations. According to the presented data, the problem of prescribing disaggregants in a combination with anticoagulants after stenting of veins remains disputable, finding however many supporters. Analysed in the article are the results of the first International Delphi Consensus dedicated to antithrombotic therapy after venous stenting. Participating in the study were 106 independent experts practicing stenting in 78 centres of 28 countries of the world. Nonthrombotic iliac vein lesions, having appeared as May-Thurner syndrome due to extravasal compression and residual obstruction after thrombolysis, as well as the presence of postthrombotic syndrome were the main 'scenarios' for our study. The study resulted in working out provisions considering the policy of antithrombotic therapy in various obstructive lesions of deep veins. According to the presented data, anticoagulant therapy is preferable during 6-12 months after stenting in nonthrombotic iliac vein lesions. Low-molecular-weight heparins appear to be a method of choice in treatment during the first 2-6 weeks. Life-long administration of anticoagulants is recommended after multiple deep vein thromboses. Discontinuation of anticoagulants after 6-12 months is indicated after venous stenting in one episode of deep vein thrombosis. No consensus was achieved regarding the role of prolonged disaggregant therapy. Underlined in the article is the importance of a meticulous individual approach to choosing optimal policy of antithrombotic therapy and determining therapeutic policy together with a haematologist.
本文是一篇文献综述，探讨了静脉支架置入术后使用抗血栓治疗的问题。文中描述了文献数据，据此作者更倾向于抗凝治疗（低分子量肝素、维生素K拮抗剂、直接口服抗凝剂）。接着考虑了根据不同临床情况确定治疗持续时间的问题。根据所提供的数据，静脉支架置入术后联合使用抗凝剂与抗血小板药物的问题仍存在争议，但也有许多支持者。本文分析了首届关于静脉支架置入术后抗血栓治疗的国际德尔菲共识的结果。参与该研究的有106位独立专家，他们在世界28个国家的78个中心从事支架置入工作。非血栓性髂静脉病变，如因血管外压迫和溶栓后残留梗阻而出现的May-Thurner综合征，以及血栓形成后综合征的存在，是我们研究的主要“情况”。该研究得出了关于深静脉各种梗阻性病变抗血栓治疗策略的规定。根据所提供的数据，在非血栓性髂静脉病变支架置入术后6至12个月内，抗凝治疗更为可取。低分子量肝素似乎是前2至6周治疗的首选方法。多次深静脉血栓形成后，建议终身服用抗凝剂。深静脉血栓形成单次发作后静脉支架置入术后6至12个月可停用抗凝剂。关于延长抗血小板治疗的作用尚未达成共识。文中强调了在选择最佳抗血栓治疗策略以及与血液科医生共同确定治疗策略时，采取细致的个体化方法的重要性。
