Direct Oral Anticoagulants Are Safe in Patients Undergoing Radiofrequency and Laser Ablation

Author Type(s)

Faculty

Document Type

Abstract

Publication Date

2022

DOI

10.1016/j.jvsv.2021.12.016

Journal Title

Journal of Vascular Surgery: Venous and Lymphatic Disorders

Department

Surgery

Abstract

Objective: As direct oral anticoagulants (DOACs) continue to be incorporated into clinical practice for long-term anticoagulation, experience with management of DOACs continues to evolve. Literature surrounding the effect of anticoagulants on endothermal ablation is limited to patients on warfarin. As such, the aim of this study was to assess the efficacy and safety of radiofrequency ablation (RFA) and endovenous laser ablation (EVLA) in patients taking DOACs. Methods: A retrospective review was performed to identify patients undergoing RFA or EVLA for symptomatic great or small saphenous venous reflux at a tertiary institution. Patients were dichotomized based on their periprocedural use of DOACs. Patients’ demographics, procedural details, and follow-up data were obtained from electronic medical records. Outcomes of interest included the rates of treated vein closure at follow-up, deep venous thrombosis (DVT), endothermal heat-induced thrombosis and major or minor bleeding periprocedurally. Cox proportional hazard modeling was used to assess factors associated with recanalization of incompetent saphenous veins. Results: There were 87 procedures performed in 69 patients receiving DOACs and 232 procedures in 295 control patients. Patients receiving DOACs were older (mean 65 years vs 55 years; P <.001) and more likely to be male (70% vs 37%; P <.001). Procedurally, RFA was used more frequently in the control group (92% vs 84%; P =.029), and longer segments of vein were treated in the control group (mean 38 mm vs 35 mm, respectively; P =.028). No major or minor bleeding and endothermal heat-induced thrombosis occurred in either group. Two patients (one RFA and one EVLA; 0.7%) in the control group developed DVT whereas no DVT was observed in the DOAC group (P =.441). At 9 months, the treated vein remained ablated after 94% of procedures performed in patients receiving DOACs and 98% of controls (Figure; log-rank P =.163). Even after adjusting for baseline differences, DOAC was not associated with an increased risk of recanalization (hazard ratio, 5.76; 95% confidence interval, 0.57-58.64; P =.139) (Table). An increased preprocedural diameter of the incompetent saphenous veins and EVLA were associated with an increased risk of recanalization. Conclusions: In this study of patients undergoing RFA or EVLA for symptomatic saphenous venous reflux, DOACs did not confer an increased risk of periprocedural bleeding or recanalization of the ablated saphenous veins at 9-months. The periprocedural use of DOACs appears safe in patients undergoing endothermal ablation. [Formula presented] [Formula presented]

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