Pharmacological thromboprophylaxis after varicose vein thermal ablation in Spain: a national survey.

BACKGROUND

Endovenous thermal ablation (EVTA) of varicose veins is now the first-line therapy for truncal reflux, yet consensus on peri-procedural pharmacological thromboprophylaxis is lacking.

METHODS

A ten-item, online, anonymized survey was distributed to all 291 members of the Spanish Chapter of Phlebology and Lymphology (CEFyL-SEACV) in February 2024. Items explored respondent demographics, anaesthesia, use, timing, drug choice and duration of pharmacological thromboprophylaxis after EVTA. Results are reported as frequencies.

RESULTS

Of 291 surgeons, 120 replied (response rate 41%, 120/291); 110 routinely performed EVTA and formed the analytic sample. Most had >10 years of venous experience (84%, 101/120) and practiced in public (48%, 58/120) or private (44%, 53/120) hospitals. Pharmacological thromboprophylaxis was prescribed by 95.5% (105/110): routinely in 80.9% (89/110) and selectively in 14.5% (16/110). Low-molecular-weight heparin (LMWH) was preferred (92.7%, 102/110); direct oral anticoagulants (DOACs) were rare (6.4%, 7/110). Prophylaxis was initiated immediately post-procedure in 39.1% (41/110), within 1-6 h in 37.1% (39/110) and ≥6 h in 22.9% (24/110). Standard duration was 6-10 days for 69.5% (73/105), whereas patients with pro-thrombotic risk factors frequently received extended courses (≥15 days in 16.2%, 17/105).

CONCLUSIONS

Spanish vascular surgeons widely adopt pharmacological thromboprophylaxis after EVTA, but timing and duration vary substantially in the absence of definitive guidelines. These findings highlight the need for a national, evidence-based consensus to harmonize practice and optimize patient safety.