利伐沙班预防静脉内激光消融联合和不联合静脉切除术的血栓形成。
Rivaroxaban for thrombosis prophylaxis in endovenous laser ablation with and without phlebectomy.
机构信息
Department of Angiology, University Hospital, Basel, Switzerland; Gefässpraxis am See - Lakeside Vascular Center, Clinic St. Anna, Lucerne, Switzerland.
Vascular Center Rapperswil, Rapperswil, Switzerland.
出版信息
J Vasc Surg Venous Lymphat Disord. 2017 Jul;5(4):515-523. doi: 10.1016/j.jvsv.2016.12.002. Epub 2017 Feb 21.
OBJECTIVE
Endovenous heat-induced thrombosis (EHIT) is a well-described complication of endovenous laser ablation (EVLA). We report our centers' experience on the efficacy (EHIT level ≥2 according to the Kabnick classification) and safety (observed major and minor bleeding events) of rivaroxaban for EHIT prophylaxis in EVLA with and without concomitant phlebectomy.
METHODS
Demographic, procedural, and outcome data of all patients with EVLA of the great, accessory, or small saphenous vein and EHIT prophylaxis with 10 mg/d rivaroxaban between 2012 and 2014 were reviewed and analyzed in this investigator-initiated multicenter retrospective observational single-arm study.
RESULTS
During a median (interquartile range) follow-up duration of 51 (41-68) days, complete vein occlusion was achieved in 98.4% of 438 EVLA procedures in 306 patients. One patient had an EHIT level 2 (0.2%; 95% confidence interval, 0.006%-1.3%). No major bleedings (0%; 95% confidence interval, 0.0%-0.8%) and six minor bleedings (1.4%; 95% confidence interval, 0.5%-3%) were observed.
CONCLUSIONS
Rivaroxaban (10 mg/d) for 5 to 10 days seems to be an efficacious and safe alternative for EHIT prophylaxis in EVLA with or without phlebectomy.
目的
静脉内热诱导血栓形成（EHIT）是静脉内激光消融（EVLA）的一种已知并发症。我们报告了我们中心在 EVLA 中使用利伐沙班预防 EHIT（根据 Kabnick 分类为 EHIT 级别≥2）的疗效（EHIT 级别≥2）和安全性（观察到的主要和次要出血事件）的经验，同时还进行了或不进行静脉切除术。
方法
在这项由研究者发起的多中心回顾性观察性单臂研究中，对 2012 年至 2014 年间接受 EVLA 治疗的大隐静脉、副大隐静脉或小隐静脉，以及接受 10mg/d 利伐沙班预防 EHIT 的所有患者的人口统计学、手术过程和结局数据进行了回顾性分析。
结果
在中位（四分位距）51（41-68）天的随访期间，306 例患者中 438 次 EVLA 手术中有 98.4%达到完全静脉闭塞。1 例患者出现 EHIT 2 级（0.2%；95%置信区间，0.006%-1.3%）。未观察到主要出血（0%；95%置信区间，0.0%-0.8%）和 6 例轻微出血（1.4%；95%置信区间，0.5%-3%）。
结论
利伐沙班（10mg/d）5-10 天似乎是 EVLA 中预防 EHIT 的有效且安全的替代方案，无论是否进行静脉切除术。
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