Must one take anticoagulants lifelong after stenting of deep veins with a non-thrombotic lesion, for example, aorto-venous conflict (May-Thurner syndrome)?
Or is it enough to take anticoagulants only in the first 6 months, until the stent grows into the vein?
Platelet aggregation is known to be important in high-flow, high-shear environment, such as in the coronary arteries, whereas coagulation may be more important in the fibrin-rich thrombi characteristic of the low-flow, low-shear venous circulation . The relative importance of antiplatelet agents versus anticoagulants has never been evaluated in clinical trials and is largely based on extrapolation from the arterial system and an understanding of the venous system. Based on clinical data on stenting of chronic iliocaval occlusions, long-term warfarin is recommended in patients with long occlusions, underlying thrombophilia, suprarenal occlusions, and previous long-term anticoagulation and poor inflow on completion angiogram [43, 44]. With postthrombotic lesions being more prone to restenosis, the use of anticoagulants appears to be useful in this subgroup. Thus, although the use of antiplatelet agents and anticoagulants has not been studied systematically, there seems to be a role for these drugs.