Tromboprofilaxia na cirurgia de varizes dos membros inferiores no Brasil
Thromboprophylaxis in lower limb varicose vein surgery in Brazil
Alcides José Araújo Ribeiro; Daniel Mendes-Pinto; Fabiano Luiz Erzinger; Rossano Kepler Alvim Fiorelli; Stênio Karlos Alvim Fiorelli; Andrea Campos de Oliveira Ribeiro; Marcos Arêas Marques
Background: Despite all the investment in primary venous thromboembolism (VTE) prophylaxis for surgical patients in recent years, there are still no specific guidelines for those who undergo procedures to treat lower limb varicose veins. Objectives: To evaluate the profile of VTE prophylaxis practices among Brazilian vascular surgeons conducting lower limb varicose vein procedures. Methods: Survey design, sending an electronic questionnaire to Brazilian vascular surgeons. Respondents were divided between those who perform saphenous vein treatment with conventional surgery and those who perform thermoablation for the purpose of comparison between groups. Results: Of 765 respondents, 405 (53%) treat saphenous veins with conventional surgery for, 44 (6%) with foam, and 199 (26%) with thermoablation (endolaser or radiofrequency). Surgeons who perform thermoablation prescribed more pharmacoprophylaxis after varicose vein surgery than those who perform conventional surgery (67/199, 34% vs. 112/405, 28%; p = 0.002). The thermoablation group stratifies patients for thromboembolism risk more frequently than the conventional surgery group (102/199, 51% vs. 179/405, 44%; p = 0.004). Both groups use enoxaparin as the most frequent drug for prophylaxis, but the thermoablation group uses proportionally more direct oral anticoagulants than the conventional surgery group (26% vs. 10%, p<0.001). Conclusions: Brazilian vascular surgeons who perform saphenous vein treatment by thermoablation prescribe pharmacoprophylaxis more frequently and for a longer period than those who use conventional surgery.
1 Machin M, Salim S, Onida S, Davies AH. Venous thromboembolism risk assessment tools: do we need a consensus? Phlebology. 2019;34(9):579-81.
2 Barker T, Evison F, Benson R, Tiwari A. Risk of venous thromboembolism following surgical treatment of superficial venous incompetence. Vasa. 2017;46(6):484-9.
3 Bhogal RH, Nyamekye IK. Should all patients undergo postoperative duplex imaging to detect a deep vein thrombosis after varicose vein surgery? World J Surg. 2008;32(2):237-40.
4 Testroote MJG, Wittens CHA. Prevention of venous thromboembolism in patients undergoing surgical treatment of varicose veins. Phlebology. 2013;28(Supl. 1):86-90.
5 Sutton PA, El-Dhuwaib Y, Dyer J, Guy AJ. The incidence of post operative venous thromboembolism in patients undergoing varicose vein surgery recorded in Hospital Episode Statistics. Ann R Coll Surg Engl. 2012;94(7):481-3.
6 van Rij AM, Chai J, Hill GB, Christie RA. Incidence of deep vein thrombosis after varicose vein surgery. Br J Surg. 2004;91(12):1582-5.
7 Cavezzi A, Parsi K. Complications of foam sclerotherapy. Phlebology. 2012;27(Supl. 1):46-51.
8 Boyle E, Reid J, O’Donnell M, Harkin D, Badger S. Thromboprophylaxis for varicose vein procedures: a national survey. Phlebology. 2019;34(9):598-603.
9 Nikolopoulos ES, Charalampidis DG, Georgakarakos EI, Georgiadis GS, Lazarides MK. Thromboprophylaxis practices following varicose veins surgery. Perspect Vasc Surg Endovasc Ther. 2012;24(2):80-6. PMid:22825421.
10 Keo HH, Knoechel J, Spinedi L, et al. Thromboprophylaxis practice after outpatient endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord. 2021;9(4):916-24.
11 Sarin S, Scurr JH, Smith PDC. Assessment of stripping the long saphenous vein in the treatment of primary varicose veins. Br J Surg. 2005;79(9):889-93.
12 Campbell WB, Ridler BM. Varicose vein surgery and deep vein thrombosis. Br J Surg. 2005;82(11):1494-7.