Impact Of Antithrombotic Treatments On Stent Patency Rate After Iliac Vein Stent Implantation:A Meta Analysis

Objective Stent implantation is the most important endovascular treatments in iliac vein diseases.Yet the antithrombotic treatments after iliac vein stent implantation are not clear.Therefore,we analyze all published literatures concerning antithrombotic treatments after iliac vein stent implantation to explore the impact of antithrombotic treatments on stent patency rate after iliac vein stent implantation.Methods Literatures concerning antithrombotic treatments after iliac vein stent implantation and stent patency rates were searched by PubMed,MEDLINE,EMBASE,Cochrane library database and so on.RCT studies were evaluated by the ystem Evaluator’s manual recommended by the Cochrane Collaboration and the qualities of cohort studies were evaluated according to Newcastle-Ottawa Scale(NOS)literature quality assessment method.The Publication bias was assessed by Begg test and Egger’s test.The included literatures were stratified into:1)Comparing the stent patency rates under different anticoagulation duration;2)Comparing stent patency rates for thrombotic and non-thrombotic iliac venous disease;3)Comparing the stent patency rates of different antithrombotic regimens.Random effects model or fixed effects model was employed according to statistical tests for homogeneity.Pooled stent patency rates were summarized by Meta-analysis then compared among different groups.Results 1)According to the inclusion and exclusion criteria,21 studies were selected with a total of 1415 patients who received antithrombotic treatments after iliac vein stent implantation involved;2)The pooled 1-year stent patency rates were 86%(95%CI=82%～89%)in the thrombotic iliac venous disease group and 96%(95%CI=89%～100%)in the non-thrombotic iliac venous disease group,respectively(P=0.010);3)The pooled 1-year stent patency rates were 89%(95%CI=84%～92%)in anticoagulation duration≥6 months group and 87%(95%CI=82%～91%)in anticoagulation duration≥3 months group(P=0.585);4)The pooled 1-year stent patency rates were 88%(95%CI=85%～92%)in the anticoagulation group and 96%(95%CI=90%～100%)in the anticoagulation combined with antiplatelet therapy group,respectively(P=0.037).Conclusion Anticoagulation for at least 3 months after iliac vein stenting was as effective as anticoagulation for at least 6 months in maintaining 1-year stent patency,we can choose anticoagulation for at least 3 months after iliac vein stenting.The 1-year patency rate after stent implantation of thrombotic iliac venous diseases is lower than that of non-thrombotic iliac venous diseases,postoperative antithrombotic therapy should be strengthened.Postoperative anticoagulation combined with antiplatelet drugs can improve the 1-year stent patency rate.