Concept of venous thromboembolism prophylaxis following endovenous thermal procedures for chronic venous disease of the lower limbs
DOI:
https://doi.org/10.14739/2310-1210.2026.3.348582Keywords:
chronic venous disease, thermal treatment methods, radiofrequency ablation, endovenous laser coagulation, venous thromboembolism, EHIT, prophylaxisAbstract
Aim. To enhance the safety and efficacy of thermal ablation procedures in patients with chronic venous disease (CVD) of the lower limbs by developing a strategy for venous thromboembolism (VTE) prevention.
Materials and methods. This single-center, prospective, open-label study included 420 consecutive patients with CVD (C2–C6). Participants underwent radiofrequency ablation (RFA, n = 206) or endovenous laser ablation (EVLA, n = 214). At the first stage, VTE risk stratification was conducted using the Caprini scale; at the second stage, the optimal thromboprophylaxis algorithm was selected. Patients were divided into two homogeneous groups. Group 1 (208 patients) received VTE prevention with standard elastic compression only, while Group 2 (212 patients) received prophylaxis based on the proposed algorithm. The incidence of postoperative VTE and bleeding complications was assessed.
Results. According to VTE risk stratification, 23.6 % of patients were classified as low risk, 63.1 % as moderate risk, 9.0 % as high risk, 3.1 % as very high risk, and 1.2 % as the highest risk. Based on the second phase analysis, 12 patients (2.9 %) of Group 1 developed thrombotic complications during the early postoperative period: EHIT class II was diagnosed in 3 cases (0.7 %) after EVLA and in 2 cases (0.5 %) after RFA. Additionally, distal deep vein thrombosis (DVT) was detected in 7 patients (1.7 %) with high VTE risk on postoperative day 7: 3 after EVLA and 4 after RFA. Implementation of the proposed thromboprophylaxis strategy significantly reduced the total incidence of thrombotic complications compared to Group 1 (0.4 % vs. 2.9 %; p = 0.031). In Group 2, only one patient (0.4 %) with moderate VTE risk was diagnosed with distal DVT. Among 39 patients (18.3 %) who received prophylactic acetylsalicylic acid or rivaroxaban, a statistically significant increase in ecchymosis occurrence was observed (p = 0.018).
Conclusions. Implementing a differentiated, risk-oriented thromboprophylaxis strategy significantly (p = 0.031) reduced the incidence of VTE from 2.9 % to 0.4 %, p = 0.031, without increasing the risk of clinically significant bleeding.
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