Effect of Pre-Procedure Clopidogrel with Iliac Vein Stenting
Pavel Kibrik, DO, Yuriy Ostrozhynskyy, Christina Monteleone, Michael Arustamyan, Artur Rozentsvit, Vera Rabinovich, Anil Hingorani, MD, Enrico Ascher, MD.
Total Vascular Care, brooklyn, NY, USA.
Objectives: Iliac vein stenting is a relatively new procedure in the treatment of chronic venous insufficiency. Research has shown that it is a safe and effective form of treatment, but there is a risk of thrombosis. In our practice, we prescribe a 3-month course of Clopidogrel after iliac vein stenting. We hypothesize that a single 75 mg dose of Clopidogrel the night prior to the procedures along with a 3-month regimen post-op would decrease the 30-day thrombosis rate.
Methods: A retrospective study was performed on 2,192 patients from September 2012 to August 2016 who received an iliofemoral stent. Patients were broken down into two main groups: those given Clopidogrel post-stent and those given Clopidogrel both pre- and post-stent. Patients were also checked for any anticoagulant medications pre- and/or post-stent. The 30-day thrombosis rates were recorded for each patient.
Results: 751 patients received Clopidogrel pre-procedurally, 1209 patients received Clopidogrel post-procedurally. 232 patients were excluded from the study because they were on other anti-coagulant medications. 70 total patients developed some degree of in-stent thrombosis (3.6%). 46 patients developed a complete thrombosis of the stent and 24 developed a partial thrombosis. Of the 751 patients who were on clopidogrel pre-stenting, 18 had a complete thrombosis and 6 had a partial in-stent thrombosis. Of the 1209 patients on Clopidogrel only post-stenting, 28 had a complete thrombosis and 18 had a partial in-stent thrombosis. Using the Chi-squared test, there were no statistically significant differences between the group of patients receiving Clopidogrel pre- and post-stent vs. just post-stent with respect to 30-day any degree of thrombosis rates (complete and partial thrombosis) (p=.48 ). Using the Chi-squared test, there were no statistically significant differences between the group of patients receiving Clopidogrel pre- and post- stent vs. just post-stent with respect to 30-day complete thrombosis rates (p=.91).
Conclusions: There appears to be no statistical difference in 30-day thrombosis rates between those receiving Clopidogrel the night prior vs. those who do not receive Clopidogrel the night prior. Therefore, we conclude that it is not necessary to give this single dose the night prior to iliac vein stenting procedures.
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