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Rivista di Angiologia
Official Journal of the , the International Union of Phlebology and the
Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
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International Angiology 2016 Sep 06
Endothermal venous ablation of the saphenous vein on patients who are on anticoagulation therapy
Shekeeb SUFIAN 1, Alejandro ARNEZ 1, Nicos LABROPOULOS 1, 2, Sanjiv LAKHANPAL 1 ✉
1 Center for Vein Restoration, Greenbelt, MD, USA; 2 Stony Brook School of Medicine, Department of Surgery, Stony Brook, NY, USA
BACKGROUND: The purpose of this study was to evaluate the risks of bleeding, deep venous thrombosis (DVT), endovenous heat induced thrombosis (EHIT) and failure of ablation on patients who undergo ablation while on oral anticoagulation.
METHODS: We compared 378 (3.4%) out of 11252 patients (Group A) who had undergone 724 endovenous ablation of the saphenous veins from January 1, 2011 to September 30, 2014 while on oral anticoagulation to a randomly selected 375 patients (Group B) who underwent 641 endovenous ablation in the same time period but were not on anticoagulation. The demographic data, history of DVT, the CEAP classification and the VCSS scores were analyzed. The indications for anticoagulation, the anticoagulants used were recorded. The primary end points were bleeding, development of DVT or EHIT, and failure of ablation.
RESULTS: Patients in Group A were older, had more men, more history of DVT and PE, had higher CEAP and VCSS scores compared to group B. The type of anticoagulation used was warfarin in 77.2% direct oral inhibitors (DOIs) in 22.8%. The rate of failure of ablation at 3 days was 39 (5.6%) for Group A and 3 (0.5%) for Group B (p<0.0001) and at one month it was 46 (10.1%) vs. 27 (6.7%) (p = 0.086). The number of EHIT cases in Group A at 3 days was 2 (0.3%), compared to 6 (0.9%) in group B (p=0.016) and at 1 month it was 0 compared to 4 (1.0%) (p=0.0483). The DVT, SVT, hematoma and wound infection rates were similar in the two groups.
CONCLUSIONS: Ablation of the saphenous veins in patients who are on oral anticoagulation is safe and does not increase the risk of bleeding or hematoma, but it may slightly lower the incidence of EHIT and increase the incidence of failure of ablation.