Prophylactic Peri-procedural Anticoagulation in Phlebology: A Survey of Current Practice

Introduction, Objectives, and/or Purpose: Phlebology is practiced in a wide range of clinical environments from in-hospital to outpatient and ambulatory settings. Doctors working in phlebology come from a wide range of training backgrounds and specialities. The spectrum of interventions is wide, ranging from treatment of telangiectasias through to truncal vein reflux.
There are currently no consensus guidelines on the use of peri-procedural anticoagulation in the context of Phlebology and venous interventions.
The authors present the findings of a survey outlining the use of formal Venous thromboembolism (VTE) risk assessment tools and anticoagulant prescribing habits of doctors working in Phlebology.
1. To determine the current practices regarding the use of VTE risk assessment tools and periprocedural anticoagulation amongst Phlebologists and Venous Interventionalists.
2. To review the literature encompassing the use of VTE screening tools in Phlebology.
3. To add to the data regarding the use of formal VTE assessment tools and prescribing of peri-procedural anticoagulation.

Methods: A survey monkey was sent to doctors working in phlebology via the database of the Australasian College of Phlebology and a small cohort of international phlebologists. The questions were designed to gain insight into current habits of VTE risk assessment and the use of peri-procedural anticoagulation by phlebologists. Responses were collected and collated in raw data form.
A review of the literature regarding evidence for the use of VTE risk assessment tools and use of prophylactic peri-procedural anticoagulation in Phlebology.

Results: The results of the survey indicate that the minority of phlebologists use a formal VTE risk assessment tool and that there is wide variation in the practices of peri-procedural anticoagulation.
The decision to use peri-procedural anticoagulation appears to be based on the doctor’s clinical acumen and experience, rather than quantitative assessment tools or formal guidelines.

Conclusion(s): Amongst the surveyed doctors, there is low uptake of use of formal assessment tools for VTE risk, and there is a wide variation in practices regarding peri-procedural anticoagulation.
Further surveys of a wider audience of doctors would provide further insight into current practices. The authors propose a formal pathway for the assessment of VTE risk and the use of peri-procedural anticoagulation in Phlebology.