Reducing the risk of venous thromboembolism following superficial endovenous treatment: A UK and Republic of Ireland consensus study

Abstract

<jats:sec><jats:title>Objectives</jats:title><jats:p> Venous thromboembolism is a potentially fatal complication of superficial endovenous treatment. Proper risk assessment and thromboprophylaxis could mitigate this hazard; however, there are currently no evidence-based or consensus guidelines. This study surveyed UK and Republic of Ireland vascular consultants to determine areas of consensus. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> A 32-item survey was sent to vascular consultants via the Vascular and Endovascular Research Network (phase 1). These results generated 10 consensus statements which were redistributed (phase 2). ‘Good’ and ‘very good’ consensus were defined as endorsement/rejection of statements by &gt;67% and &gt;85% of respondents, respectively. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> Forty-two consultants completed phase 1. This generated seven statements regarding risk factors mandating peri-procedural pharmacoprophylaxis and three statements regarding specific pharmacoprophylaxis regimes. Forty-seven consultants completed phase 2. Regarding venous thromboembolism risk factors mandating pharmacoprophylaxis, ‘good’ and ‘very good’ consensus was achieved for 5/7 and 2/7 statements, respectively. Regarding specific regimens, ‘very good’ consensus was achieved for 3/3 statements. </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> The main findings from this study were that there was ‘good’ or ‘very good’ consensus that patients with any of the seven surveyed risk factors should be given pharmacoprophylaxis with low-molecular-weight heparin. High-risk patients should receive one to two weeks of pharmacoprophylaxis rather than a single dose. </jats:p></jats:sec>

Mechanochemical ablation for great and small saphenous veins insufficiency in patients with type III shunt

“…Currently, there is not solid evidence-based justification, but a recent consensus in UK and Ireland concluded that prophylaxis with low-molecular-weight heparin following superficial endovenous treatment is recommended. 29…”

UK Royal Society of Medicine Venous Forum VTE Advice 2020

“…Practice varies greatly for low risk patients, ranging from never giving prophylaxis; to using a single or multiple doses of LMWH depending on the perception of the patient and clinicians' individual preferences. 2 There is no good evidence for any of these practices and this is likely to remain the case because of the very low incidence of VTE in this patient group. Because these are not the patients of primary concern the RSMVF Advice simply includes the regimes that are commonly used.…”

“…The Advice specifies three levels of risk for patients – low risk patients, for whom no good evidence exists to guide practice; high risk patients, who should receive prophylaxis because of their obvious risk factors; and an intermediate group at “additional risk”, who probably should receive adequate pharmacological prophylaxis but commonly do not. 2 For both of the latter groups, the Advice recommends more prolonged prophylaxis than that typically used by many clinicians.…”

“…The intermediate group – namely patients with single risk factors – was seen as especially important, because there is evidence that these patients may not receive deserved pharmacological prophylaxis, probably because endovenous procedures are perceived as low-risk for VTE. 2 This is the group in whom the occasional occurrence of VTE is most likely, with adverse potentially very serious consequences for both patient and clinician. There is unlikely to be a good defence if legal action is taken against a clinician who has failed to provide prophylaxis for a patient with demonstrable risk factors.…”

Profilaxia de tromboembolismo venoso para pacientes hospitalizados

“…Por exemplo, na UTI a incidência de TVP é de 29-31% sem profilaxia e de 12% com profilaxia adequada. 2,5 Como a TEP fatal pode ser a primeira manifestação clínica, é inapropriado aguardar o aparecimento de sintomas para diagnosticar e tratar um episódio de TEV. Além disso, a detecção da TVP pode ser difícil, já que apenas cerca da metade dos pacientes tem quadro clínico evidente.…”