Periprocedural Thromboprophylaxis for Superficial Venous Interventions: A Literature Review

Foam sclerotherapy and endovenous thermal ablation (EVTA) with radiofrequency and laser are common treatments for superficial venous insufficiency. Despite the safety and effectiveness of EVTA, serious life-threatening thrombotic complications can occur. The overall incidence of endovenous heat-induced thrombosis, deep vein thrombosis, and pulmonary embolism after EVTA has been reported to be <1.5%. Several attempts to evaluate periprocedural thromboprophylaxis for superficial venous interventions have shown heterogeneous findings. Therefore, there is an absence of high-quality evidence to establish recommendations or clinical guidelines. We reviewed the current evidence on thromboprophylaxis and summarized the recent evidence. We conducted an extensive literature review of studies reported in the past 10 years in PubMed, Science, Google Scholar, and Cochrane. We used the following terms: “superficial venous insufficiency,” “thromboprophylaxis,” “endovenous laser ablation,” “foam sclerotherapy,” “deep venous thrombosis,” “venous thromboembolism,” and “thrombotic complications.” We included systematic reviews, retrospective cohort studies, and consensus documents. A total of 10 reports were included in the review. The current evidence is heterogeneous. The overall incidence rates of endovenous heat-induced thrombosis and deep vein thrombosis for patients who had not received thromboprophylaxis were <1.5%. In the cohorts that received thromboprophylaxis, the rates of thrombotic complications showed a modest reduction of <0.9% without increased bleeding complications. The duration of the treatment varied between 12 hours before to 21 days after the procedure. The administered drugs were rivaroxaban, fondaparinux, and heparin, with different doses. In some cases, the Caprini score was used to decide who received thromboprophylaxis, with the score varying from >3 to >8 points. Additionally, a significant portion of the current literature was based on consensus and expert opinion. Thrombotic complications are infrequent and usually have a benign course; however, clinical providers should perform an individual risk assessment of every patient undergoing superficial venous interventions. We found significant variability in the type of drug, duration of treatment, and selection criteria used. The heterogeneity of periprocedural thromboprophylaxis in superficial venous interventions emphasizes the need for large multicenter randomized clinical trials to provide standardized evidence-based guidelines.