The routine use of Rivaroxaban as thromboprophylaxis following endovenous thermal ablation

Background: We investigated the safety and efficacy of rivaroxaban as routine thromboprophylaxis after endovenous thermal ablation (EVTA). Patients and methods: Adhering to the PRISMA 2020 guidelines, we conducted a systematic review for studies published up to April 2024. Primary endpoints included endovenous heat-induced thrombosis (EHIT) class ≥ II, deep vein thrombosis (DVT), major and minor bleeding and the composite endpoint of major thromboembolic complications including any incidents of EHIT ≥ III, DVT or pulmonary embolism (PE). Results: Eight retrospective case series, encompassing 1666 patients, and 2049 truncal veins were included. The pooled EHIT ≥ II, DVT, and major thromboembolic complications estimates were 0.73% (95% CI: 0.37-1.42), 0.51% (95% CI: 0.22-1.17) and 0.71% (95% CI: 0.27-1.89). The crude and pooled major and minor bleeding estimates were 0% (0/885) and 2.60% (95% CI: 1.05-6.33). The pooled early truncal and great saphenous vein (GSV) occlusion outcomes were 99.03% (95% CI: 96.88-99.70) and 98.74% (95% CI: 92.07-99.81). The pooled and crude superficial thrombophlebitis and PE estimates were 2.86% (95% CI: 0.88-8.89) and 0% (0/579). While the comparative analysis between rivaroxaban and low molecular weight heparins (LMWH)/fondaparinux displayed improved outcomes favouring rivaroxaban in terms of DVT, risk ratio (RR), 0.60 (95% CI: 0.12-3.07) and truncal occlusion, odds ratio (OR), 1.43 (95% CI: 0.31-6.55) outcomes did not reach statistical significance. Meta-regression analysis including rivaroxaban treatment durations spanning from three to ten days displayed a negative association between duration of treatment and both truncal, (β = -0.4740, p<0.01) and GSV, (β = -0.4583, p<0.01) occlusion in the early pos-operative period. Conclusions: The results of this review underscore the potential safety of rivaroxaban as thromboprophylaxis in the context of endovenous thermal ablation. The observed inverse relationship between anticoagulation duration and occlusion outcomes should be interpreted with caution, highlighting the need for further research.