Continuation of anticoagulation through ambulatory phlebectomy does not impact postoperative bleeding risk

Abstract

Objectives

Chronic anticoagulation for atrial fibrillation, a history of venous thromboembolism, and after heart valve replacement is often stopped or bridged for surgery. Our institutional practice is to continue anticoagulation through ambulatory phlebectomy (AP) procedures. As such, we aimed to compare postprocedure bleeding and major adverse events in patients on anticoagulation who received AP compared with patients not on anticoagulation.

Methods

We included all patients who required AP from January 2016 to February 2023. Given the low frequency of chronic anticoagulation during the study period, as defined as patients on anticoagulation ≥30 days before index procedure and not held through the procedure, a propensity score match of 16 demographic parameters was performed to better match patients. After propensity matching, we compared the frequency and quality of postprocedural bleeding (none, incisional, large volume), extent of postprocedural ecchymosis (none, minimal, moderate, significant), and pain (minimal, moderate, severe) on follow-up examination with a provider. Thirty-day emergency department (ED) visits and major adverse cardiac events were also recorded for each patient. Continuous variables were compared using independent t tests or Mann-Whitney U tests, and categorical variables were compared using a χ² or Fisher's exact test.

Results

In total, 1853 patients received AP from four outpatient offices during the study period, 101 (5.5%) of whom were on chronic anticoagulation. Seventy patients for each group were propensity score matched in key demographics including age, gender, body mass index, Clinical-Etiology-Anatomy-Pathophysiology classification, prior vein procedures, concomitant laser procedures, number of phlebectomies performed, and comorbidities like history of deep vein thrombosis, pulmonary embolism, and peripheral arterial disease. There were no intraoperative major bleeding events. Patients on chronic anticoagulation were not more likely to have increased postprocedural bleeding (2.9% vs 0%; P > .05), significant ecchymosis (4.5% vs 1.5%; P = .671), severe pain on follow-up (1.4% vs 0%; P > .05), or increased likelihood of postprocedural cellulitis (1.4% vs 0%; P > .05). There were no instances of 30-day ED visits or major adverse cardiac events. Within patients on anticoagulation, use of rivaroxaban (8%) had higher incidence of bleeding than those on apixaban or warfarin (0%); however, these findings were not significant.

Conclusions

AP while continuing chronic anticoagulation did not result in an increased rate of bleeding, ED visits, or major adverse events. It is likely safe to continue anticoagulation throughout these outpatient procedures.