Influence of warfarin on the success of endovenous laser ablation (EVLA) of the great saphenous vein (GSV).
BACKGROUND
Although warfarin is routinely stopped prior to varicose vein surgery the absence of incisions may make this unnecessary prior to EVLA. Nevertheless continuing therapy may compromise ablation rates resulting in treatment failure. Since EVLA is particularly suitable for older patients with co-morbidities this study investigates whether warfarin influences outcome.


METHODS
A prospective observational cohort study was designed to assess ablation rates (1 year, duplex ultrasound), Aberdeen varicose vein symptom severity scores (AVVSS) and patient satisfaction following GSV EVLA in 22 patients ("warfarin group": 12 female, 10 male; 24 limbs) taking warfarin and 24 age/sex and disease-severity matched controls who were not taking anticoagulants ("no-warfarin group").


RESULTS
Complete ablation of the treated-length of GSV was achieved in 20/24 (83%) limbs in the "warfarin group" versus 23/24 (96%) in the "no-warfarin" group (p=0.347, chi squared). Suboptimal energy densities were delivered to 3/4 failures in the "warfarin group". A similar, significant (p<0.001, Wilcoxon) improvement in AVVSS occurred in both groups [warfarin: median 14.6 (inter-quartile range 8.9-19.1) to 3.8 (1.9-6.2), no-warfarin: median 13.9 (IQR 7.6-20.1) to 3.5 (2.2-6.4)]. Patients were equally satisfied with outcomes (warfarin=92%, no-warfarin=90%; p=0.391, Mann-Whitney). No major complications occurred.


CONCLUSIONS
EVLA in patients taking warfarin is safe and effective. Since cessation of therapy is unnecessary it should provide a valuable alternative to surgery in these patients.
Theivacumar
N S
NS
Leeds Vascular Institute, The General Infirmary at Leeds, Leeds, UK.
Gough
M J
MJ
D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D016022:Case-Control Studies; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012501:Saphenous Vein / Q000601:surgery*; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects
D000925:Anticoagulants; D014859:Warfarin