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Radiofrequency Or Laser Vein Ablation For Patients On Anticoagulation Is Safe, Effective, And Durable
Gregory G. Westin, MD, MAS, Victoria T. Lee, MD, Jonathan Ekstroem-Knudsen, Patricia Yau, MD, Mikel Sadek, MD, Lowell S. Kabnick, MD, Glenn R. Jacobowitz.
NYU Langone Medical Center, New York, NY, USA.
Objective(s): To evaluate the efficacy, durability, and safety of radiofrequency (RFA) and endovenous laser (EVLA) ablation of the great saphenous and small saphenous veins to treat symptomatic venous reflux in patients on therapeutic anticoagulation.
Methods: Patients treated at a single institution with RFA or EVLA while on anticoagulation were identified retrospectively, along with a representative sample of patients not on anticoagulation who were similarly treated. Patient demographics, comorbidities, procedural details, and follow-up data were obtained from electronic medical records. Outcomes included the rates of persistent vein ablation, bleeding, deep venous thrombosis (DVT), and endothermal heat-induced thrombosis (EHIT).
Results: 101 procedures were performed in 65 patients on anticoagulation and 128 procedures in 89 control patients. Mean follow-up time was 253 days. The most common indications for anticoagulation were atrial fibrillation (52%), remote DVT (29%), and mechanical heart valves (8%). Patients on anticoagulation were on average older (median age 68 vs. 52 years); more likely to be male (51% vs. 27%); and had higher rates of coronary disease (9% vs. 0%) and hypertension (55% vs. 20%). 129 procedures were RF (56%); 100 were EVLA (44%). 191 procedures treated the great saphenous (83%) and 38 treated the small saphenous vein (17%).
Over the follow-up period, the target vessel remained ablated following 93% (94/101) of procedures performed on anticoagulation and 97% (124/128) without anticoagulation (Figure 1, P=0.51). Rates of persistent ablation did not differ significantly by vessel treated (P=0.35), EVLA vs. RFA (P=0.58), or use of antiplatelet therapy (P=0.96). One patient had bleeding from a phlebectomy site 2 days post-procedurally when supratherapeutic on warfarin; this was controlled with pressure. DVT in the ipsilateral leg occurred within 90 days following 1/101 (1%) procedures on anticoagulation and 2/128 (1.6%) procedures in control patients; EHIT rates were similarly 1/101 (1%) on anticoagulation and 1/128 (0.8%) in control patients.
Conclusions: This is the largest study to date of endothermal ablation in patients on anticoagulation. Durability, safety, and efficacy are similar with and without anticoagulation. Anticoagulation should not be considered a contraindication to endothermal ablation of the great saphenous or small saphenous veins for symptomatic venous reflux.
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