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Anticoagulation, Recanalization, And Complication Rates After Venous Ablation - An Analysis Of The Vascular Quality Initiative Registry
Vivek Anand Pisharody, Jonathan Gunasti, Shuting Mao, Ravi R. Rajani, MD, Christopher Ramos, MD, Manuel Garcia-Toca, Tianwen Ma, PhD, Jaime Benarroch-Gampel, MD.
Emory University, Atlanta, GA, USA.
Objectives The impact of anticoagulation on outcomes after venous ablation has been a subject of debate. Prior single-center studies with small cohorts have suggested post-intervention complication rates are unaffected by anticoagulation, with conflicting results on rates of post-intervention recanalization. In this study, we assess the relationship between anticoagulation and complications, clinical improvement, and recanalization rates.
MethodsPatients undergoing thermal and non-thermal venous ablation procedures between January 2015 and December 2018 were identified from the varicose vein module of the Vascular Quality Initiative. Patient demographic and clinical data, anticoagulation status, procedure characteristics, and post-operative course were queried from the database. Multivariate logistic regression and Cox proportional hazards models were used to compare outcomes between anticoagulated and non-anticoagulated patients. Subgroup analysis was then conducted comparing thermal and non-thermal ablation methods.
Results17,585 patients were identified, including 999 patients who underwent venous ablation while anticoagulated. A total of 26,861 procedures were performed, of which 16,501 (61.4%) treated the great saphenous vein. In 19,510 (72.6%) of the procedures a thermal technique was used. There were no differences in rates of post-operative complications between anticoagulated and non-anticoagulated groups. Anticoagulated patients were less likely to self-report symptom improvement on a Heaviness-Achiness-Swelling-Throbbing-Iching (HASTI) scale (52.7% vs 47.6%, p<0.001), thought both groups had comparable HASTI score improvement (-6.63 points vs -6.26 points, p=0.0683). On multivariate regression, anticoagulation was associated with significantly higher rates of recanalization (OR 2.67, 95% CI 1.642-4.176, p < 0.001), when adjusted for age, sex, pre-intervention CEAP class, and ablation type. On time-to-event analysis with Cox proportional hazards modeling (Figure 1), anticoagulation was also associated with significantly worse recanalization-free survival (OR 2.77, 95% CI 1.76-4.39, p<0.001). On subgroup analysis, anticoagulated patients had worse recanalization-free survival regardless of whether thermal (OR 2.56, p<0.001) or non-thermal (OR 5.89, p<0.001) techniques were used.
ConclusionsAlthough anticoagulated patients had comparable complication rates and clinical improvement as non-anticoagulated patients, rates of recanalization and recanalization-free survival time were significantly worse in anticoagulated patients. In patients whose thrombotic risk prevents temporary discontinuation of anticoagulation, venous ablation procedures can be safely performed, but higher rates of post-intervention surveillance should be considered.
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