Anti-DVT Prophylaxis in Patients Undergoing Thermal Endovenous Treatment: Use of a Simple Scoring System

Objectives: Venous thromboembolism (VTE) is a rare but potentially life-threatening complication of superficial endovenous treatment. Use of VTE risk assessment to guide pharmacological prophylaxis could mitigate this danger. However, currently there is no accepted management of VTE risk in these, usually fit, ambulatory patients. Methods: We retrospectively reviewed our use of Worcester score (VTE risk assessment tool) in all patients who underwent endovenous thermal ablation using the bipolar radiofrequency device (radiofrequency induced thermal therapy, RFITT) from January 2013 to December 2018. All cases were performed by a single Vascular consultant at a single NHS trust. Patient demographics, treatment parameters and VTE prophylaxis method were retrospectively analysed from a prospectively collected database. Results: 481 patients who underwent RF ablation between 2013 and 2018 were assessed. There were no clinical or duplex detected DVTs. 436 patients (90.6%) had a Worcester score of ‘0’ and were not given any additional pharmaco-prophylaxis. 42 patients (8.8%) had positive scores and were treated with extended anticoagulation. Of the 42 patients, 18 (40%) scored 1 and were given 7 days of additional prophylaxis and 24 (60%) scored 2 or more and were treated for two or more weeks. Conclusions: VTE is a life-threatening complication of ambulatory endovenous treatment. The current state of pharmacological thromboprophylaxis practice is highly variable and subjective. A selective VTE prevention strategy which involves risk-assessing all patients for VTE and managing those at increased risk with additional anticoagulant prophylaxis extended into the post-procedure period is a safe and effective strategy based on our experience.