A Retrospective Analysis of Endovascular Stent Insertion for Malignant Superior Vena Cava Obstruction, Focusing on Anticoagulation Practices.

BACKGROUND/OBJECTIVES: A knowledge gap persists regarding anticoagulation therapy after endovascular stent insertion for malignant superior vena cava obstruction (mSVCO). Guidelines are supported by retrospective studies with a radiological focus and lack specific drug recommendations. No studies to date have captured the multi-disciplinary nature of decision-making over time. METHODS: This single-center retrospective service evaluation includes patients with solid organ malignancy who received a stent for mSVCO between July 2016 and May 2022. Patient and treatment characteristics, clinical outcomes and prescribing decisions were collected from medical records and analyzed. RESULTS: Of 49 patients (55% female, mean age 59), 73% had metastatic extra-thoracic disease at stent insertion. Technical success was achieved in 98% of cases and 92% survived to discharge. Forty-eight patients were followed until death. Median survival was 2.4 months. Post-procedure imaging (performed in 55% of patients) revealed 10 (21%) cases of systemic venous thromboembolism and 7 cases of stent thrombosis. Forty-four (91%) patients received anticoagulation therapy (62% therapeutic dose low molecular weight heparin). Those with thrombotic complications were fitter pre-procedurally than the rest of the cohort. There was one case of major bleeding. Twenty-two instances of therapy modification occurred following the initial plan, including nine changes due to a patient preference for oral therapy. CONCLUSION: Patients undergoing stenting for mSVCO demonstrate high thrombotic risk and a poor prognosis. Anticoagulation plans are frequently modified post discharge due to changing risk profiles and patient preferences. Multi-disciplinary collaboration is essential to support patient-centered and individualized management. Future research should investigate direct oral anticoagulants and anti-platelet therapy and develop risk assessment tools for this population.