Anticoagulation for DVT Post-Endovascular Ablation of Varicose Veins: Network Meta-Analysis

Introduction Deep vein thrombosis (DVT) is an established risk associated with endovascular ablation for varicose veins,1%. Anticoagulantion is the mainstay of treatment in the event of a DVT. Several anticoagulants ar available to choose from. This network meta-analysis compares anticoagulation regimes used in patients who develop a DVT post endovascular ablation for varicose veins Aim Primary aim is to compare anticoagulation therapies and duration used in the event of DVT post endovascular ablation of varicose veins. Secondary aim to quantify the extent of secondary bleeding due to anticoagulation. Methods Medline, Embase, CINAHL and Cochrane Library databases were searched using appropriate terms for all studies reporting on DVT post endovascular ablation for varicose veins. Methodological quality of included studies was quantifed using the Downs and Black checklist. Results 407 articles were identifed from preliminary searches with 22 studies satisfying the inclusion criteria. The analysis consisted of 63,076 patients with post-ablative DVT occurring in 358 patients. The anticoagulation regime was left to the treating physician in majority of cases. Agents commonly used were low-molecular weight heparin (LMWH), warfarin, a combination of both or direct oral anticoagulants (DOAC). Duration of therapy varied considerably among studies. Bleeding events related to anticoagulation are low and the need for intervention is lower again. Conclusion Although there has been a move towards DOAC in recent years, LMWH appears to remain the agent of choice for patients with post ablative DVT. The consensus for the duration of treatment is yet to be determined.