Efficacy of using rivaroxaban for treatment of heat-induced thrombosis after endovenous laser ablation

Fokin A.A.¹, Borsuk D.A.², Kazachkov E.L.³

1) Department of Surgery of the Institute of Additional Professional Education of the South Ural State Medical University under the Public Health Ministry of the Russian Federation,
2) Clinic of Phlebology and Laser Surgery, Limited Liability Company "Vasculab",
3) Department of Pathological Anatomy and Forensic Medicine of the South Ural State Medical University under the Public Health Ministry of the Russian Federation, Chelyabinsk, Russia

Objective: The study was aimed at assessing efficacy of using rivaroxaban for treatment of endothermal heat-induced thrombosis (EHIT) after endovenous laser ablation (EVLA) of saphenous veins.

Materials and methods: Our prospective study included a total of 1,326 patients subjected to 1,514 EVLAs. In 1,091 (72.1%) cases the great saphenous vein (GSV) was ablated, in 124 (8.2%) cases the anterior accessory vein (AAV) was treated and in 299 (19.7%) cases the small saphenous vein (SSV) was treated. Heat-induced thrombosis developed in 21 (1.4%) cases: in 19 cases in the basin of the great saphenous vein and in 2 cases in the anterior accessory saphenous vein. No heat-induced thromboses in the basin of the small saphenous vein were observed. In 9 (0.6%) cases there was class 1 EHIT (according to the Kabnick classification), class 2 EHIT was noted in 10 (0.7%) cases and class 3 EHIT was observed in 2 (0.1%) cases. All patients with EHIT were given rivaroxaban: patients with class 1 EHIT received it at a single daily dose of 20 mg, patients with class 2 and 3 EHIT – at a dose of 15 mg twice daily.

In one (4.8%) case the drug had to be discontinued on day two due to the development of dyspeptic events. All patients were found to have complete regression of the heat-induced thrombus within 6-25 days. No cases of clinical manifestations of pulmonary artery thromboembolism were observed.

A conclusion was drawn that in clinical practice EHIT is an important and insufficiently studied problem. Rivaroxaban may be used as an oral agent for treatment of heat-induced thromboses after EVLA. Further studies are required to examine its efficacy and safety profile.

KEY WORDS: endovenous heat-induced thrombosis, endovenous laser coagulation, rivaroxaban.

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