下肢静脉曲张热消融术后预防性抗凝在日间 模式中的应用价值

Application Value of Prophylactic Anticoagulation Following Thermal Ablation for Lower Extremity Varicose Veins in a Day Surgery

摘要: 研究目的：探究下肢静脉曲张热消融术后预防性抗凝在日间模式中的应用价值。研究方法：收集2023年12月至2024年6月接受日间下肢静脉曲张热消融术的330例患者资料，最终纳入297例，其中术后接受预防性抗凝组148例(依诺肝素4000 IU术后皮下注射 + 利伐沙班10 mg/d口服5 d)，非抗凝组149例。比较两组术后1周内深静脉血栓(DVT)、出血事件发生率及临床基线资料。连续变量根据正态性采用t检验或Mann‑Whitney U检验，分类变量采用卡方检验，出血事件行贝叶斯分析。结果：两组DVT发生率(抗凝组0% vs. 非抗凝组1.3%，p = 0.157)和出血事件发生率(抗凝组4.1% vs. 非抗凝组2.0%，p = 0.305)差异均无统计学意义；贝叶斯分析支持两组出血事件无差异。抗凝组Caprini评分中位数(IQR)为4.0 (4.0~5.0)，高于非抗凝组的4.0 (3.0~5.0)，差异有统计学意义(p < 0.001)。其余基线指标(身体质量指数、年龄、大隐静脉直径、凝血指标等)组间未见统计学差异。结论：在日间模式中，下肢静脉曲张热消融术后预防性抗凝并未对VTE发生产生显著影响，对Caprini评分较高的患者可能存在潜在益处，且不会增加出血事件发生。

Abstract: Objective: To investigate the value of prophylactic anticoagulation after thermal ablation for lower extremity varicose veins in a day surgery. Methods: Data of 330 patients who underwent day surgery thermal ablation for lower extremity varicose veins from December 2023 to June 2024 were collected. A total of 297 patients were finally included, of whom 148 received postoperative prophylactic anticoagulation (subcutaneous enoxaparin 4000 IU followed by oral rivaroxaban 10 mg/d for 5 days) and 149 did not. The incidence of deep vein thrombosis (DVT) and bleeding events within one week postoperatively, as well as baseline clinical data, were compared between the two groups. Continuous variables were analyzed using t-test or Mann‑Whitney U test based on normality, categorical variables using chi‑square test, and bleeding events were further analyzed using Bayesian analysis. Results: No statistically significant differences were observed between the two groups in the incidence of DVT (0% in the anticoagulation group vs. 1.3% in the non‑anticoagulation group, p = 0.157) or bleeding events (4.1% vs. 2.0%, p = 0.305). Bayesian analysis supported no difference in bleeding events between the groups. The median (IQR) Caprini score was significantly higher in the anticoagulation group [4.0 (4.0~5.0)] than in the non‑anticoagulation group [4.0 (3.0~5.0)] (p < 0.001). No significant differences were found in other baseline variables, including body mass index, age, great saphenous vein diameter, and coagulation parameters. Conclusion: In the day surgery setting, prophylactic anticoagulation after thermal ablation for lower extremity varicose veins does not significantly affect the occurrence of VTE. It may offer potential benefits for patients with higher Caprini scores and does not increase the risk of bleeding events.