Endothermal venous ablation of the saphenous vein on patients who are on anticoagulation therapy.
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 641endovenous ablation in the same time period but were not on anticoagulation. The demographic data, history of DVT, the Clinical, Etiologic, Anatomic, Pathologic (CEAP) classification and the VCSS (Venous Clinical Severity Score) scores were analyzed. The indications for anticoagulation, the anticoagulants used were recorded. The primary endpoints 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.
Center for Vein Restoration, Greenbelt, MD, USA - shekeeb.sufian@centerforvein.com.
Shekeeb
S
Sufian
Center for Vein Restoration, Greenbelt, MD, USA.
Alejandro
A
Arnez
Center for Vein Restoration, Greenbelt, MD, USA.|Stony Brook School of Medicine, Department of Surgery, Stony Brook, NY, USA.
Nicos
N
Labropoulos
Center for Vein Restoration, Greenbelt, MD, USA.
Sanjiv
S
Lakhanpal
D055011:Ablation Techniques / Q000009:adverse effects*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use*; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012501:Saphenous Vein / Q000601:surgery*; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014481:United States; D014648:Varicose Veins / Q000628:therapy*; D014689:Venous Insufficiency / Q000628:therapy*; D020246:Venous Thrombosis / Q000453:epidemiology; D014859:Warfarin / Q000627:therapeutic use*; D055815:Young Adult
D000925:Anticoagulants; D014859:Warfarin