Antithrombotic therapy after endovenous iliocaval intervention

DOAC: direct oral anticoagulant; DVT: deep venous thrombosis; IVUS: intravascular ultrasound.

* IVUS is typically used to determine whether angioplasty or stenting are appropriate by delineating the nature and severity of any underlying venous lesions in real time.

¶ Lesions are regarded as thrombotic (ie, DVT) or nonthrombotic. For iliocaval thrombosis, catheter-directed thrombectomy/thrombolysis is used first to remove the clot and uncover any underlying venous stenosis.

Δ Angioplasty may not be warranted if there is no stenosis after thrombolysis or only a mild venous stenosis that is not flow limiting.

◊ Intravenous heparin is transitioned postprocedurally to the selected oral agent, typically a DOAC. The duration of anticoagulation depends on whether the underlying anatomic venous pathology provoked the DVT, and if follow-up imaging demonstrates complete resolution of clot burden and the underlying stenosis.

§ Antiplatelet therapy is individualized according to the risk of bleeding. Regimens are derived from expert opinion but there is no consensus on which approach provides better patency.