Outcomes of Patients at Risk for Deep Venous Thrombosis Undergoing Endovenous Ablation on Systemic Anticoagulation
Peter Beaulieu, Jennifer Watson, MD, FACS, RPVI.
Spectrum Health Medical Group Vein Center, Grand Rapids, MI, USA.
There is much debate about the care of patients who are at high risk for Deep Vein Thrombosis (DVT) and significant venous reflux disease. The purpose of this study is to evaluate the outcomes of patients undergoing endovenous ablation while on short-term or long-term systemic anticoagulation (AC) therapy as compared to patients undergoing endovenous ablation not on anticoagulation (NAC) therapy. Endovenous ablations are performed on high risk patients while on systemic AC therapy. There is evidence that supports this practice; however, there is no standard of care.
Patients were prospectively enrolled based on their Caprini Thrombosis Risk Factor Assessment score, and anticoagulation therapy status. Patients already on an anticoagulant continued with their prescribed therapy. Patients with high risk factors were started on anticoagulation therapy at the providerís discretion using a standard Lovenox protocol. Data collection was performed approximately 3 months post-procedure.
Preliminary results were calculated from 211 patients (19 AC therapy/192 NAC therapy). The Fishers Exact calculation was used to analyze the association between the occurrence of DVT, hematoma, minor bleeding, vein closure rate success, and the need for repeat endovenous ablation, and the anticoagulation therapy status of the patient (AC versus NAC). There was no statistically significant evidence to support that any of these occurrences have an association with the anticoagulation therapy status of the patient. Data was also collected for the occurrence of pulmonary embolus and major bleeding although there were no occurrences of these events.
Table 1: Association of Events and Anticoagulation Therapy Status
|Events||AC (N=19)||NAC (N=192)||p-value|
|Deep Vein Thrombosis (Yes)||0 (0.0)||1 (0.5)||>0.999|
|Pulmonary Embolism (Yes)||0 (0.0)||0 (0.0)||N/A|
|Hematoma Right Leg (Yes)||1 (5.9)||2 (1.2)||0.3461|
|Hematoma Left Leg (Yes)||0 (0.0)||1 (0.6)||0.6055|
|Minor Bleeding (Yes)||1 (5.6)||8 (4.8)||>0.999|
|Major Bleeding (Yes)||0 (0.0)||0 (0.0)||N/A|
|Blood Transfusion (Yes)||0 (.0.0)||0 (0.0)||N/A|
|Vein Closure Successful (Yes)||18 (94.7)||187 (99.5)||0.1756|
|Repeat RFA (Yes)||1 (5.3)||1 (0.5)||0.1772|
Note: Values are presented as frequency (percent).
At this time the preliminary results have not shown any statistically significant differences in the outcomes of patients on AC verses NAC therapy. Factors limiting these results may be the low enrollment of patients on AC therapy and the low prevalence of the analyzed occurrences. This research project will continue to enroll additional patients and re-analyze the post-procedure data collected.
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