An updated approach to the risk assessment and prevention of postoperative venous thromboembolism in varicose vein surgery
Lobastov K.V. Shaldina M.V. Borsuk D.A. Kochetkov S.V. Schastlivtsev I.V. Laberko L.A. Fokin A.A.
2024Remedium Group Ltd
Ambulatornaya Khirurgiya
2024#21Issue 2244 - 257 pp.
This narrativeliterature review is dedicated to the issue of individual risk assessment and prevention of postoperative VTE in patients undergoing lowerlimb varicose vein surgery. The registry-based CAPSIVS trial showed that the detection frequency of any forms of VTE after modern minimally invasive superficial vein surgery reaches 3.4%, of which only 0.5% are symptomatic. The current clinical guidelines regulate the individual risk assessment of postoperative thrombosis using the Caprini Risk Score (CRS). The first validation study resulted in a proposal of evidence-based approach to the phlebological patient stratification into risk groups according to the Caprini scores with 0–6 scores indi-cating thelow risk, 7–10 scores – the moderate risk and 11 scores or more –the high risk, which differs significantly from approaches in other medical specialties. At the same time, the pharmacoprophylaxis may be appropriate in the groups of moderate and high risk, especially when simultaneous varicose tributary ablation and perforating vein interventions increasing the risk of VTEC 6–11 times are performed. The dura-tion of pharmacoprophylaxis of postoperative venous thrombosis is essential to its efficiency, which should not be less than 7 days for the moderate VTE risk group and reach 30 days for the high VTE risk group. A single injection of parenteral anticoagulants on the day of surgery has been shown to be associated with an 8.8% incidence of postoperative thrombosis. The risk of postoperative thrombosis in patients with VTE in their past medical history, including prior varicothrombophlebitis is increased by 4.2 times, which requires that secondary pharma-coprophylaxis be prescribed for at least 30 days, and in some cases up to 3-6 months. At this stage, there is sufficient evidence to support the use of the Caprini Risk Score to assess the risk of postoperative VTE and prescribe adequate pharmacological prophylaxis in varicose vein surgery treatment.
Caprini risk score , preventive measures , risk assessment , varicose vein disease , venous thromboembolic events
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Department of General Surgery named after V.M. Buyanov, Pirogov Russian National Research Medical University, 1, Ostrovityanov St, Moscow, 117997, Russian Federation
Clinic of Phlebology and Laser Surgery “VenoClinica”, 50, Pushkin St., Chelyabinsk, 454091, Russian Federation
Department of Surgery, Faculty of Postgraduate and Additional Professional Education, Institute of Additional Professional Education, South Ural State Medical University, 64, Vorovsky St., Chelyabinsk, 454092, Russian Federation
Department of Surgery with a course in Anesthesiology and Resuscitation, Kazakhstan-Russian Medical University, 51/53, Abylay Khan Ave., Almaty, 050004, Kazakhstan
Department of General Surgery named after V.M. Buyanov
Clinic of Phlebology and Laser Surgery “VenoClinica”
Department of Surgery
Department of Surgery with a course in Anesthesiology and Resuscitation
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