Endothermal heat-induced thrombosis (EHIT) is a potential complication of radiofrequency ablation (RFA). Data on effective prophylaxis of EHIT are limited. In 2018, a high-volume, single institution implemented strategies to decrease the incidence of EHIT, including a single periprocedural prophylactic dose of low-molecular-weight heparin to patients with a great saphenous vein (GSV) diameter of ≥8 mm or saphenofemoral junction (SFJ) diameter of ≥10 mm and limiting treatment to one vein per procedure. The size threshold was derived from existing literature. The study objective was to evaluate the effects of these institutional changes on thrombotic complication rates after RFA. A retrospective cohort control study was conducted using the Vascular Quality Initiative database. Data were collected for patients who underwent RFA with a GSV diameter of ≥8 mm or SFJ diameter of ≥10 mm from January 2015 to July 2022. The clinical end points were thrombotic complications (ie, thrombophlebitis, EHIT, deep vein thrombosis) and bleeding complications. Patient demographic and procedural variables were included in the analysis, and significant variables after univariable logistic regression were included in a multivariable logistic regression. After the policy change, the overall vein center EHIT rate decreased from 2.6% to 1.5%, with a trend toward significance ( = .096). The inclusion criterion of a GSV diameter of ≥8 mm or an SFJ diameter of ≥10 mm yielded 845 patients, of whom 298 were treated before the policy change and 547 after. There was a significant reduction in the rate of EHIT classified as class ≥III (2.34 vs 0.366; = .020) after the institutional changes. Treatment of two or more veins and an increased vein diameter were associated with an increased risk of EHIT ( = .049 and < .001, respectively). No significant association was found between periprocedural anticoagulation and all-cause thrombotic complications or EHIT ( = .563 and = .885, respectively). The institutional policy changes have led to lower rates of EHIT, with a reduction in severe EHIT rates in patients with an ≥8-mm diameter GSV or a ≥10-mm diameter SFJ treated with RFA. Of the changes implemented, restricting treatment to one vein was associated with a reduction in severe EHIT. No association was found with periprocedural low-molecular-weight heparin, although a type 2 error might have occurred. Alternative strategies to prevent thrombotic complications should be explored, such as increasing the dosage and duration of periprocedural anticoagulation, antiplatelet use, and nonpharmacologic strategies.

中文翻译：

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降低射频消融后严重吸热热诱发血栓形成率的策略

吸热热诱导血栓形成（EHIT）是射频消融（RFA）的潜在并发症。关于有效预防 EHIT 的数据有限。 2018 年，一家大容量单一机构实施了降低 EHIT 发生率的策略，包括对大隐静脉 (GSV) 直径 ≥8 mm 或隐股交界处的患者进行单次围手术期预防性低分子量肝素剂量(SFJ) 直径≥10 毫米，每次手术仅治疗一根静脉。大小阈值来自现有文献。研究目的是评估这些制度变化对 RFA 后血栓并发症发生率的影响。使用血管质量倡议数据库进行了一项回顾性队列对照研究。收集 2015 年 1 月至 2022 年 7 月期间 GSV 直径≥8 mm 或 SFJ 直径≥10 mm 接受 RFA 的患者的数据。临床终点为血栓并发症（即血栓性静脉炎、EHIT、深静脉血栓形成）和出血并发症。患者人口统计和程序变量包含在分析中，单变量逻辑回归后的显着变量包含在多变量逻辑回归中。政策变化后，整体静脉中心EHIT率从2.6%下降至1.5%，呈显着趋势（=.096）。根据 GSV 直径≥8 mm 或 SFJ 直径≥10 mm 的纳入标准，纳入了 845 名患者，其中 298 名患者在政策变更前接受治疗，547 名患者在政策变更后接受治疗。制度变革后，EHIT 被分类为 ≥ III 级的比率显着下降（2.34 对比 0.366；= .020）。两条或更多静脉的治疗以及静脉直径的增加与 EHIT 风险增加相关（分别 = .049 和 < .001）。围手术期抗凝与全因血栓并发症或 EHIT 之间没有发现显着关联（分别 = .563 和 = .885）。机构政策的变化导致 EHIT 发生率降低，接受 RFA 治疗的直径 ≥8 毫米的 GSV 或直径 ≥10 毫米的 SFJ 患者的严重 EHIT 率降低。在实施的改变中，将治疗限制在一根静脉与严重 EHIT 的减少有关。尽管可能发生了 2 型错误，但未发现与围手术期低分子量肝素相关。应探索预防血栓并发症的替代策略，例如增加围手术期抗凝的剂量和持续时间、抗血小板药物的使用和非药物策略。