Effectiveness of Post-operative Single-dose Anticoagulant with Compression Therapy in Preventing Deep Vein Thrombosis after Thermal Ablation of Varicose Veins

Abstract

Abstract Introduction: Deep vein thrombosis (DVT) and pulmonary embolism are relatively common diseases and are amenable to therapy but with a potentially fatal outcome if untreated. It is not clear whether patients undergoing varicose vein surgeries should receive a thromboprophylaxis. Furthermore, there is no consensus amongst surgeons with regard to the prevention of venous thromboembolism in patients undergoing surgical treatment for varicose veins. The objective of our study was to assess the effectiveness of post-operative single-dose anticoagulant with 48 h of compression therapy in preventing DVT after thermal ablation for varicose veins under spinal anaesthesia. Materials and Methods: A prospective observational study was conducted amongst 115 patients undergoing endovenous thermal ablation procedure for varicose veins in the Department of General Surgery, Trivandrum. After obtaining detailed history, all patients were assessed clinically for symptoms and signs of varicose veins and graded according to CEAP grading. The patients underwent pre-operative ultrasound Doppler study as per hospital protocol. Thermal ablation (radiofrequency/laser) was done in all selected patients after getting informed consent. Endovenous thermal ablation of veins was done using radiofrequency probe/laser catheter inserted inside the vein under ultrasound guidance after giving tumescence around the vein with normal saline. Phlebectomy of superficial varicosities was done. After thermal ablation of veins and phlebectomy, compression bandaging was given for the limb and continued for 48 h. Single-dose injection enoxaparin 0.4 ml subcutaneous was given after 8 h of procedure. The patient was encouraged for ambulation after recovery from anaesthesia. The patient was examined for swelling, pain, difference in circumference of limb, haematoma formation and appearance of skin and if indicated Doppler study to detect any presence of DVT at post-operative day (POD) 3, 2nd week and 6th week. Then, the proportion of patients developing DVT was taken as a primary outcome. Results: None of the patients in the study group was detected to have DVT of the lower limb during pre-operative venous Doppler study and none of the patients enrolled showed symptoms or signs of DVT during the clinical assessment at POD 3, 2nd week and 6th week after the procedure and a low incidence of DVT is found after thermal ablation procedures. Conclusion: Our study concludes that the use of post-operative single-dose anticoagulant and 48 h of compression therapy and early ambulation as prophylaxis measures prevents DVT.