Systematic Review and Meta-analysis of the Additional Benefit of Pharmacological Thromboprophylaxis for Endovenous Varicose Vein Interventions

Abstract

Objective: The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) after endovenous interventions for varicose veins in the presence of pharmacological and mechanical thromboprophylaxis versus mechanical thromboprophylaxis alone. Background: The VTE rate after endovenous procedures for varicose veins is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42021274963). Studies of endovenous intervention for superficial venous incompetence reporting the predefined outcomes with at least 30 patients were eligible. Data were pooled with a fixed effects model. Results: There were 221 trials included in the review (47 randomized trial arms, 105 prospective cohort studies, and 69 retrospective studies). In randomized trial arms, the rate of deep venous thrombosis with additional pharmacological thromboprophylaxis was 0.52% (95% CI, 0.23%–1.19%) (9 studies, 1095 patients, 2 events) versus 2.26% (95% CI, 1.81%–2.82%) (38 studies, 6951 patients, 69 events) with mechanical thromboprophylaxis alone. The rate of pulmonary embolism in randomized trial arms with additional pharmacological thromboprophylaxis was 0.45% (95% CI, 0.09–2.35) (5 studies, 460 participants, 1 event) versus 0.23% (95% CI, 0.1%–0.52%) (28 studies, 4834 participants, 3 events) for mechanical measures alone. The rate of EHIT grade III to IV was 0.35% (95% CI, 0.09–1.40) versus 0.88% (95% CI, 0.28%–2.70%). There was 1 VTE-related mortality and 1 instance of major bleeding, with low rates of minor bleeding. Conclusions: There is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis and routine prescription of anticoagulation after endovenous varicose vein intervention should be considered. VTE risk for individual study participants is heterogeneous and risk stratification in future randomized interventional studies is critical to establish the clinical effectiveness and safety of additional pharmacological thromboprophylaxis.

An Updated Systematic Review and Meta-Analysis of the Impact of Graduated Compression Stockings in Addition to Pharmacological Thromboprophylaxis for Prevention of Venous Thromboembolism in Surgical Inpatients

“…An intrinsic problem in studies of VTE is the heterogeneous risk profile of individual participants. The lack of risk stratification in studies of VTE was recently highlighted in an extensive systematic review and meta-analysis of VTE rates after endovenous interventions for varicose veins, and it was recommended that risk stratification tools, such as the Caprini score, be adopted in future studies 47,48 . In the context of this study, it may be that the participants with the highest risk of VTE stood to gain the most from combined GCS and pharmacological thromboprophylaxis, but unfortunately due to lack of standardized risk stratification, the role of GCS in this context remains uncertain.…”

Evaluating pharmacological THRomboprophylaxis in Individuals undergoing superficial endoVEnous treatment across NHS and private clinics in the UK: a multi-centre, assessor-blind, randomised controlled trial—THRIVE trial

“…To address this, we conducted an analysis of 229 study arms, pooling data from 480 581 participants undergoing endovenous interventions. Our approach involved subgroup analyses, comparing those receiving pharmacological thromboprophylaxis and compression versus compression alone, and distinguishing between asymptomatic screen-detected and symptomatic VTE 24…”

“…Contradicting NICE guidelines, the routine use of pharmacological thromboprophylaxis for SET has become prevailing practice, despite having no supportive evidence base. A systematic review and meta-analysis published in 2022 failed to identify any high-quality evidence to support current pharmacological thromboprophylaxis strategies in this group of patients 24. However, the study suggested that there is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis (1.09% vs 3.20% for pharmacological thromboprophylaxis vs compression alone).…”

COVID-19-associated phlebopathy – myth or reality?

“…В-третьих, приведенные уровни биомаркеров могут быть следствием не специфического вирусного поражения эндотелия, а банальной гиподинамии на фоне длительного пребывания в изоляции, перехода на дистанционную работу и глобального изменения образа жизни в период пандемии. Предыдущие исследования показали, что даже у здоровых добровольцев без признаков патологии венозной системы возможно обнаружить локальное увеличение концентрации IL-6 в образцах крови из вен нижних конечностей [9], а ортостатическая нагрузка в течение 30-60 мин может спровоцировать повышение уровня таких маркеров эндотелиальной дисфункции, как ELAM-1 (E-селектин), ICAM-1, VCAM-1 (молекулы клеточной адгезии), аннексин V и микрочастицы [10,11]. Таким образом, предполагаемая вирус-индуцированная флебопатия на деле может оказаться хорошо известной ортостатической (гипостатической) функциональной венозной недостаточностью.…”