Cleary Colin M, Orosco Emily, Gallagher James, Gallagher James, Ayach Mouhanad, Davoudi Kaveh, Bailey Allison, Shah Parth, Aitcheson Elizabeth, Li Ya-Huei, Wrana Kristy, Gifford Edward D
University of Connecticut School of Medicine, Farmington, CT.
Hartford Hospital Division of Vascular and Endovascular Surgery, Hartford, CT.
J Vasc Surg Venous Lymphat Disord. 2025 May;13(3):102199. doi: 10.1016/j.jvsv.2025.102199. Epub 2025 Jan 29.
Chronic anticoagulation for atrial fibrillation, a history of venous thromboembolism, and after heart valve replacement is often stopped or bridged for surgery. Our institutional practice is to continue anticoagulation through ambulatory phlebectomy (AP) procedures. As such, we aimed to compare postprocedure bleeding and major adverse events in patients on anticoagulation who received AP compared with patients not on anticoagulation.
We included all patients who required AP from January 2016 to February 2023. Given the low frequency of chronic anticoagulation during the study period, as defined as patients on anticoagulation ≥30 days before index procedure and not held through the procedure, a propensity score match of 16 demographic parameters was performed to better match patients. After propensity matching, we compared the frequency and quality of postprocedural bleeding (none, incisional, large volume), extent of postprocedural ecchymosis (none, minimal, moderate, significant), and pain (minimal, moderate, severe) on follow-up examination with a provider. Thirty-day emergency department (ED) visits and major adverse cardiac events were also recorded for each patient. Continuous variables were compared using independent t tests or Mann-Whitney U tests, and categorical variables were compared using a χ or Fisher's exact test.
In total, 1853 patients received AP from four outpatient offices during the study period, 101 (5.5%) of whom were on chronic anticoagulation. Seventy patients for each group were propensity score matched in key demographics including age, gender, body mass index, Clinical-Etiology-Anatomy-Pathophysiology classification, prior vein procedures, concomitant laser procedures, number of phlebectomies performed, and comorbidities like history of deep vein thrombosis, pulmonary embolism, and peripheral arterial disease. There were no intraoperative major bleeding events. Patients on chronic anticoagulation were not more likely to have increased postprocedural bleeding (2.9% vs 0%; P > .05), significant ecchymosis (4.5% vs 1.5%; P = .671), severe pain on follow-up (1.4% vs 0%; P > .05), or increased likelihood of postprocedural cellulitis (1.4% vs 0%; P > .05). There were no instances of 30-day ED visits or major adverse cardiac events. Within patients on anticoagulation, use of rivaroxaban (8%) had higher incidence of bleeding than those on apixaban or warfarin (0%); however, these findings were not significant.
AP while continuing chronic anticoagulation did not result in an increased rate of bleeding, ED visits, or major adverse events. It is likely safe to continue anticoagulation throughout these outpatient procedures.
对于心房颤动、有静脉血栓栓塞病史以及心脏瓣膜置换术后的患者，长期抗凝治疗在手术时常常会中断或采用桥接治疗。我们机构的做法是在门诊静脉切除术（AP）过程中继续进行抗凝治疗。因此，我们旨在比较接受AP治疗的抗凝患者与未接受抗凝治疗的患者术后出血情况和主要不良事件。
我们纳入了2016年1月至2023年2月期间所有需要进行AP的患者。鉴于研究期间长期抗凝治疗的频率较低，即索引手术前接受抗凝治疗≥30天且手术过程中未停药的患者，我们对16个人口统计学参数进行了倾向评分匹配，以更好地匹配患者。倾向评分匹配后，我们比较了术后出血的频率和性质（无、切口出血、大量出血）、术后瘀斑范围（无、轻微、中度、显著）以及随访时医生检查的疼痛情况（轻微、中度、重度）。还记录了每位患者30天内急诊科就诊情况和主要不良心脏事件。连续变量采用独立t检验或Mann-Whitney U检验进行比较，分类变量采用χ²检验或Fisher精确检验进行比较。
在研究期间，共有1853名患者在四个门诊办公室接受了AP治疗，其中101名（5.5%）患者正在接受长期抗凝治疗。在年龄、性别、体重指数、临床-病因-解剖-病理生理学分类、既往静脉手术、同期激光手术、静脉切除数量以及深静脉血栓形成病史、肺栓塞和外周动脉疾病等合并症等关键人口统计学特征方面，每组70名患者进行了倾向评分匹配。术中无重大出血事件。接受长期抗凝治疗的患者术后出血增加的可能性并不更高（2.9%对0%；P>.05），显著瘀斑的发生率也不更高（4.5%对1.5%；P = 0.671），随访时严重疼痛的发生率也不更高（1.4%对0%；P>.05），术后蜂窝织炎的发生率增加的可能性也不更高（1.4%对0%；P>.05）。没有30天内急诊科就诊或主要不良心脏事件的病例。在接受抗凝治疗的患者中，使用利伐沙班（8%）的出血发生率高于使用阿哌沙班或华法林的患者（0%）；然而，这些结果并不显著。
在继续长期抗凝治疗的同时进行AP治疗，不会导致出血、急诊科就诊或主要不良事件发生率增加。在这些门诊手术过程中继续抗凝治疗可能是安全的。
