Chemothromboprophylaxis in Varicose Vein Surgery - A Systematic Review

Abstract

Introduction: Venous Thromboembolism (VTE) is a possible complication after varicose vein surgery, reported after both open and endovascular interventions. Nonetheless, there are no internationally accepted recommendations regarding post-operative VTE prevention strategies, with some authors advocating for its use, while others recommend against it. This study aims to systematically review current evidence on the efficacy and safety of chemothromboprophylactic strategies after varicose vein surgery. Evidence Acquisition: A literature search was performed on the MEDLINE, Scopus, SciELO and Web of Science databases, which returned 532 studies. Ten studies were included. Data were extracted using piloted forms. Evidence Synthesis: A total of 6929 patients were included for analysis, out of which 70.4% were treated by open surgery (n=4878) and 29.6% by endovenous procedures (n=2051; 79.1% EVLA; 20.9% RFA). VTE chemothromboprophylaxis was performed in 76.3% of the patients (n=5284), from which 62.5% were treated by open surgery (n=3301) and 37.5% by endovenous interventions (n=1983). Among those treated by open surgery, reported deep venous thrombosis (DVT) rates ranged between 0-6.25% while pulmonary embolism (PE) was reported in 0-0.07% of the cases. Regarding endovenous interventions, EHIT and DVT rates ranged between 0-2.5% and 0-0.9%, respectively, with no cases of PE described. The remaining 23.7% of the patients did not underwent VTE chemothromboprophylaxis (n=1645), with DVT and PE rates after open surgery ranging between 0-5.17% and 0-1.48%, respectively. Only one study reported thrombotic complications after endovenous interventions in this subgroup of patients, with post-operative EHIT rates of 7.3%, and no information regarding PE or DVT. Bleeding complications were higher in patients undergoing chemothromboprophylaxis (0-10.2%) when compared to those who did not (0-0.18%) and were more frequent after endovenous interventions (0-10.2% versus 0-0.75% after open surgery). Conclusions: VTE is a possible complication after both open and endovascular varicose vein interventions, although overall VTE complications appear to occur less frequently after endovascular procedures. There's a clear heterogeneity regarding peri and post-operative chemoprophylaxis regimens used. Further studies are required to stratify risk factors and indications for chemothromboprophylaxis after varicose vein surgery.