Management of VTE following superficial endovenous treatment: a global survey

Introduction: Superficial endovenous intervention is the recommended treatment for symptomatic varicose veins. However, venous thromboembolism (VTE) remains a known complication. Guidelines, including those from the National Institute for Health and Care Excellence (NICE) and European Society for Vascular Surgery (ESVS), are largely opinion-based and recommend an individualised approach to pharmacological thromboprophylaxis. However, clinical practices vary: some clinicians routinely prescribe pharmacological thromboprophylaxis while others do not. This survey examined global practices in pharmacological thromboprophylaxis for superficial endovenous interventions and identified regional and treatment trends. Methods: An online survey was distributed via professional societies and social media platforms to healthcare professionals involved in endovenous interventions. It was piloted before dissemination and included questions on participant demographics, treatment modalities and pharmacological thromboprophylaxis use. Responses were analysed descriptively, summarised as frequencies and percentages, and categorised by region and treatment type. Results: A total of 263 valid responses were analysed, with vascular surgeons comprising the majority of responders (68%, n=178). Most participants were from Europe (64%, n=170) and North America (18%, n=48), while representation from South America (8%, n=20), Asia (6%, n=15), Africa (3% n=7) and Australasia (1%, n=3) was more limited. Ultrasound-guided foam sclerotherapy (UGFS) was the most commonly performed procedure, offered by 77% (n=141) of individuals in private, 70% (n=67) in public and 60% (n=41) in academic settings. Geographic variations were observed in pharmacological thromboprophylaxis use, with fewer North American clinicians prescribing it to average- and higher-risk patients compared to other regions. Among respondents prescribing extended direct oral anticoagulant (DOAC) thromboprophylaxis, rivaroxaban was the most common choice for both thermal (77%, n=41) and non-thermal techniques (75%, n=27), followed by apixaban (19%) and edoxaban (4% and 6%, respectively). Most respondents (69%, n=174) reported routinely risk-stratifying patients before treatment, with higher-risk individuals more likely to receive pharmacological thromboprophylaxis. The choice of DOACs for extended thromboprophylaxis showed minimal regional variation. Conclusions: This survey highlights a global lack of consensus on VTE risk assessment and thromboprophylaxis in superficial endovenous interventions. High-quality evidence is needed to establish standardised guidelines and improve patient outcomes. The generalisability of these findings is limited, particularly in regions where no responses were collected, such as large parts of Africa, the Middle East and areas of Asia and South America. Small sample sizes in certain regions and self-reported data reliance introduce potential selection and reporting bias. These limitations highlight the need for broader, more inclusive research and robust statistical analysis to ensure globally applicable recommendations.