Venous Thrombosis Prophylaxis after Endovenous and Open Surgery for Varicose Veins: A Systematic Review and Network Meta-Analysis

Abstract

Background

Varicose vein surgery increases the risk of venous thromboembolism (VTE). Although pharmacological thromboprophylaxis is commonly used postoperatively, its efficacy and optimal regimen remain unclear. This study systematically reviews the effectiveness and safety of various anticoagulant strategies.

Methods

A comprehensive literature search was conducted across PubMed, Embase, EBSCO, and Web of Science databases to identify relevant studies. Eligible studies were screened and selected based on predefined inclusion and exclusion criteria. A network meta-analysis was performed to compare different anticoagulant agents and prophylaxis durations indirectly. Additionally, a random-effects meta-analysis was conducted to calculate the relative risk (RR) and 95% confidence intervals (CI) for VTE and bleeding outcomes.

Results

A total of 11 studies, including 7359 patients who underwent either endovenous or open surgical procedures for varicose veins, met the inclusion criteria. Meta-analysis results indicated that pharmacological thromboprophylaxis was associated with a lower risk of VTE compared to no prophylaxis (RR = 0.49, 95% CI: 0.12-1.99, P < 0.01); however, this difference was not statistically significant. Similarly, there was no significant difference in bleeding risk between patients who received anticoagulant prophylaxis and those who did not (RR = 2.03, 95% CI: 0.82-5.07, P = 0.81). Furthermore, network meta-analysis revealed no significant differences in the incidence of thromboembolic events or bleeding risk across various prophylaxis durations (3, 5, and 10 days) or among different anticoagulants, including low-molecular-weight heparin (LMWH), rivaroxaban, heparin, apixaban, and sulodexide.

Conclusions

Postoperative anticoagulant prophylaxis for VTE following varicose vein surgery appears to be safe; however, its effectiveness in reducing VTE incidence remains uncertain. The lack of significant differences in outcomes across different prophylaxis durations and anticoagulant types highlights the need for further high-quality, large-scale randomized controlled trials to establish the optimal prophylactic strategy, including the appropriate agent, dosage, and duration.