asurgeryАмбулаторная хирургияAmbulatornaya khirurgiya = Ambulatory Surgery (Russia)2712-87412782-2591ООО «ГРУППА РЕМЕДИУМ»10.21518/1995-1477-2022-19-2-62-71asurgery-310Research ArticleАНГИОЛОГИЯANGIOLOGYСовременное состояние проблемы оценки риска и профилактики венозных тромбоэмболических осложнений после термической облитерации поверхностных венCurrent state of the problem of risk assessment and prevention of venous thromboembolic complications after thermal obliteration of superficial veinshttps://orcid.org/0000-0002-5358-7218ЛобастовК. В.LobastovK. V.

Лобастов Кирилл Викторович -кандидат медицинских наук, доцент кафедры общей хирургии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Kirill V. Lobastov -Cand. Sci. (Med.), Associate Professor of the Department of General Surgery of the Faculty of Medicine.

1, Ostrovityanov St., Moscow, 117997

lobastov_kv@mail.ruhttps://orcid.org/0000-0001-8288-7773ШалдинаМ. В.ShaldinaM. V.

Шалдина Мария Викторовна, врач – сердечно-сосудистый хирург.

454091, Челябинск, ул. Пушкина, д. 50

Maria V. Shaldina -Vascular Surgeon.

50, Pushkin St., Chelyabinsk, 454091

m.shaldina@mail.ruhttps://orcid.org/0000-0003-1455-9916БорсукД. А.BorsukD. A.

Борсук Денис Александрович -кандидат медицинских наук, главный врач, КФЛХ «VenoClinica»; ассистент кафедрой хирургии факультета послевузовского и дополнительного профессионального образования Института дополнительного профессионального образования, Южно-Уральский ГМУ.

454091, Челябинск, ул. Пушкина, д. 50; 454091, Челябинск, ул. Пушкина, д. 50

Denis A. Borsuk -Cand. Sci. (Med.), Chief Physician, CPLS “VenoClinica”; Assistant of the Department of Surgery, Faculty of Postgraduate and Additional Professional Education, Institute of Additional Professional Education, SUSMU.

50, Pushkin St., Chelyabinsk, 454091; 64, Vorovsky St., Chelyabinsk, 454092

borsuk-angio@mail.ruhttps://orcid.org/0000-0002-1306-1502СчастливцевИ. В.SchastlivtsevI. V.

Счастливцев Илья Вениаминович -кандидат медицинских наук, доцент кафедры общей хирургии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Ilya V. Schastlivtsev -Cand. Sci. (Med.), Associate Professor of the Department of General Surgery, Faculty of Medicine.

1, Ostrovityanov St., Moscow, 117997

Schastlivtsev.ilya@gmail.comhttps://orcid.org/0000-0002-5542-1502ЛаберкоЛ. А.LaberkoL. A.

Лаберко Леонид Александрович, доктор медицинских наук, профессор кафедры общей хирургии лечебного факультета.

117997, Москва, ул. Островитянова, д. 1

Leonid A. Laberko -Dr. Sci. (Med.), Professor of the Department of General Surgery, Faculty of Medicine.

1, Ostrovityanov St., Moscow, 117997

laberko@list.ruhttps://orcid.org/0000-0001-5411-6437ФокинА. А.FokinА. A.

Фокин Алексей Анатольевич -доктор медицинских наук, профессор, заведующий кафедрой хирургии факультета послевузовского и дополнительного профессионального образования Института дополнительного профессионального образования.

454091, Челябинск, ул. Пушкина, д. 50

Alexey A. Fokin -Dr. Sci. (Med.), Professor, Head of the Department of Surgery, Faculty of Postgraduate and Additional Professional Education, Institute of Additional Professional Education.

64, Vorovsky St., Chelyabinsk, 454092

alanfokin@yandex.ruРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationКлиника флебологии VenoClinicaРоссияClinic of Phlebology and Laser Surgery VenoClinicaRussian FederationКлиника флебологии VenoClinica; Южно-Уральский государственный медицинский университетРоссияClinic of Phlebology and Laser Surgery VenoClinica; South Ural State Medical UniversityRussian FederationЮжно-Уральский государственный медицинский университетРоссияSouth Ural State Medical UniversityRussian Federation2022191120221926271Copyright © Лобастов К.В., Шалдина М.В., Борсук Д.А., Счастливцев И.В., Лаберко Л.А., Фокин А.А., 20222022Лобастов К.В., Шалдина М.В., Борсук Д.А., Счастливцев И.В., Лаберко Л.А., Фокин А.А.Lobastov K.V., Shaldina M.V., Borsuk D.A., Schastlivtsev I.V., Laberko L.A., Fokin А.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.a-surgeon.ru/jour/article/view/310

Венозные тромбоэмболические осложнения (ВТЭО) после современных малоинвазивных вмешательств на поверхностных венах являются нечастым, но весьма драматичным событием. В статье представлен обзор литературы, освещающий вопросы распространенности, возможности прогнозирования и фармакологической профилактики ВТЭО. Проведенные исследования демонстрируют, что частота развития симптоматических тромботических осложнений после эндовенозной термической облитерации не превышает 0,5%, но с учетом бессимптомных термически индуцированных тромбозов и субклинических окклюзий мышечных вен голени эта цифра может превышать 10%. При этом отмечается высокая гетерогенность данных, возможно, обусловленная различиями в индивидуальном риске ВТЭО. Для оценки последнего наиболее валидированным инструментом является шкала Каприни, которая не была достаточным образом изучена при хирургическом лечении варикозной болезни. Назначение профилактических доз антикоагулянтов после термической облитерации подкожных вен находит широкое применение в рутинной клинической практике, несмотря на отсутствие убедительных доказательств целесообразности такого подхода. В последние годы в качестве альтернативы гепаринам большую популярность приобрело использование прямых оральных антикоагулянтов вопреки официальной инструкции (офф-лейбл). Наибольшая доказательная база накоплена в отношении применения ривароксабана 10 мг, что ассоциируется с высокой эффективностью и безопасностью. Опираясь на завершенные клинические исследования, на сегодняшний день не представляется возможным сформулировать однозначные рекомендации по назначению профилактических доз антикоагулянтов после термической облитерации поверхностных вен. Требуются дополнительные исследования для идентификации пациентов с индивидуально повышенным риском тромбоза, у которых применение профилактических доз антикоагулянтов может иметь максимальное преимущество.

Venous thromboembolic complications (VTEO) after modern minimally invasive superficial vein interventions are an infrequent but very dramatic event. This article presents a review of the literature, covering the issues of prevalence, prognosis and pharmacological prevention of VTEO. The performed studies demonstrate that the incidence of symptomatic thrombotic complications after endovenous thermal obliteration does not exceed 0,5%, but taking into account asymptomatic thermally induced thromboses and subclinical occlusions of the muscular veins of the lower leg, this figure can exceed 10%. There is a high heterogeneity of the data, possibly due to differences in the individual risk of VTEO. The most validated tool for assessing the latter is the Caprini Scale, which has not been sufficiently studied in the surgical treatment of varicose veins. The administration of prophylactic doses of anticoagulants after thermal obliteration of saphenous veins is widely used in routine clinical practice, despite the lack of convincing evidence for the appropriateness of this approach. In recent years, the use of direct oral anticoagulants against the official instruction (off-label) has gained great popularity as an alternative to heparin. The largest evidence base has accumulated for the use of rivaroxaban 10 mg, which is associated with high efficacy and safety. Based on completed clinical trials, it is not possible to formulate unequivocal recommendations for prophylactic anticoagulant doses after thermal obliteration of superficial veins at this time. Additional studies are required to identify patients with an individually increased risk of thrombosis in whom prophylactic doses of anticoagulants may be of maximum benefit.

варикозная болезньэндовенозная термическая облитерацияэндовенозная лазерная коагуляциярадиочастотная абляцияшкалаvaricose vein diseaseendovenous thermal obliterationendovenous laser coagulationradiofrequency ablationCaprini Scalepharmacological prophylaxisvenous thromboembolic complicationsReferencesBrar R., Nordon I.M., Hinchliff R.J., Loftus I.M., Thompson M.M. Surgical management of varicose veins: meta-analysis. Vascular. 2010;18(4):205–220. https://doi.org/10.2310/6670.2010.00013.Brar R., Nordon I.M., Hinchliff R.J., Loftus I.M., Thompson M.M. Surgical management of varicose veins: meta-analysis. Vascular. 2010;18(4):205–220. https://doi.org/10.2310/6670.2010.00013.Malgor R.D., Gasparis A.P., Labropoulos N. Morbidity and mortality after thermal venous ablations. Int Angiol. 2016;35(1):57–61. Режим доступа: https://pubmed.ncbi.nlm.nih.gov/25673309/.Malgor R.D., Gasparis A.P., Labropoulos N. Morbidity and mortality after thermal venous ablations. Int Angiol. 2016;35(1):57–61. Режим доступа: https://pubmed.ncbi.nlm.nih.gov/25673309/.Healy D.A., Kimura S., Power D., Elhaj A., Abdeldaim Y., Cross K.S. et al. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. Eur J Vasc Endovasc Surg. 2018;56(3):410–424. https://doi.org/10.1016/j.ejvs.2018.05.008.Healy D.A., Kimura S., Power D., Elhaj A., Abdeldaim Y., Cross K.S. et al. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. Eur J Vasc Endovasc Surg. 2018;56(3):410–424. https://doi.org/10.1016/j.ejvs.2018.05.008.Borsuk D.A., Sadek M., Kabnick L.S. Current status of endothermal heat induced thrombosis. Int Angiol. 2021;40(4):277–282. https://doi.org/10.23736/s0392-9590.21.04667-8.Borsuk D.A., Sadek M., Kabnick L.S. Current status of endothermal heat induced thrombosis. Int Angiol. 2021;40(4):277–282. https://doi.org/10.23736/s0392-9590.21.04667-8.Barker T., Evison F., Benson R., Tiwari A. Risk of venous thromboembolism following surgical treatment of superficial venous incompetence. Vasa. 2017;46(6):484–489. https://doi.org/10.1024/0301-1526/a000656.Barker T., Evison F., Benson R., Tiwari A. Risk of venous thromboembolism following surgical treatment of superficial venous incompetence. Vasa. 2017;46(6):484–489. https://doi.org/10.1024/0301-1526/a000656.Pannucci C.J., Shanks A., Moote M.J., Bahl V., Cederna P.S., Naughton N.N. et al. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg. 2012;255(6):1093–1099. https://doi.org/10.1097/SLA.0b013e3182519ccf.Pannucci C.J., Shanks A., Moote M.J., Bahl V., Cederna P.S., Naughton N.N. et al. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg. 2012;255(6):1093–1099. https://doi.org/10.1097/SLA.0b013e3182519ccf.Nemoto H., Mo M., Ito T., Inoue Y., Obitsu Y., Kichikawa K. et al. Venous thromboembolism complications after endovenous laser ablation for varicose veins and role of duplex ultrasound scan. J Vasc Surg Venous Lymphat Disord. 2019;7(6):817–823. https://doi.org/10.1016/j.jvsv.2019.06.014.Nemoto H., Mo M., Ito T., Inoue Y., Obitsu Y., Kichikawa K. et al. Venous thromboembolism complications after endovenous laser ablation for varicose veins and role of duplex ultrasound scan. J Vasc Surg Venous Lymphat Disord. 2019;7(6):817–823. https://doi.org/10.1016/j.jvsv.2019.06.014.Боренштейн А.И., Юмин С.М., Мишакина Н.Ю., Бабакова Н.А., Миронов А.В., Андрияшкин А.В., Золотухин И.А. Венозные тромбоэмболические осложнения у больных, перенесших флебэктомию при варикозной болезни нижних конечностей. Флебология. 2012;6(4):11–15. Режим доступа: https://www.mediasphera.ru/issues/flebologiya/2012/4/031997-6976201244.Borenshteyn A.I., Yumin S.M., Mishakina N.Yu., Babakova N.A., Mironov A.V., Andriyashkin A.V., Zolotukhin I.A. Venous thromboembolism after phlebectomy in patients with primary varicose veins. Flebologiya. 2012;6(4):11–15. (In Russ.) Available at: https://www.mediasphera.ru/ issues/flebologiya/2012/4/031997-6976201244.Золотухин И.А., Юмин С.М., Боренштейн А.И., Андрияшкин А.В., Бабакова Н.А., Агафонов В.Ф., Кириенко А.И. Профилактика венозных тромбоэмболических осложнений после флебэктомии: результаты сравнительного исследования двух тактических подходов. Флебология. 2013;7(3):10–16. Режим доступа: https://www.mediasphera.ru/issues/flebologiya/2013/3/031997-6976201332.Zolotukhin I.A., Yumin S.M., Borenshteyn A.I., Andriyashkin A.V., Babakova N.A., Agafonov V.F., Kirienko A.I. Prevention of venous thromboembolism after phlebectomy: results of a comparative study of two different tactics. Flebologiya. 2013;7(3):10–16. (In Russ.) Available at: https://www.mediasphera.ru/issues/flebologiya/2013/3/031997-6976201332.Lobastov K., Vorontsova A., Bargandzhiya A., Tsaplin S., Schastlivtsev I., Barinov V. et al. The frequency and clinical significance of nontarget superficial and deep vein occlusion after physician compounded foam sclerotherapy of varicose tributaries. Phlebology. 2020;35(6):430–439. https://doi.org/10.1177/0268355519898595.Lobastov K., Vorontsova A., Bargandzhiya A., Tsaplin S., Schastlivtsev I., Barinov V. et al. The frequency and clinical significance of nontarget superficial and deep vein occlusion after physician compounded foam sclerotherapy of varicose tributaries. Phlebology. 2020;35(6):430–439. https://doi.org/10.1177/0268355519898595.Parsi K., Panozzo B., Bull A., Yang A., Kang M., Parsi Y., Connor D.E. Deep vein sclerosis following sclerotherapy: Ultrasonic and D-dimer criteria. Phlebology. 2020;35(5):325–336. https://doi.org/10.1177/0268355519873534.Parsi K., Panozzo B., Bull A., Yang A., Kang M., Parsi Y., Connor D.E. Deep vein sclerosis following sclerotherapy: Ultrasonic and D-dimer criteria. Phlebology. 2020;35(5):325–336. https://doi.org/10.1177/0268355519873534.Sufian S., Arnez A., Labropoulos N., Lakhanpal S. Incidence, progression, and risk factors for endovenous heat-induced thrombosis after radiofrequency ablation. J Vasc Surg Venous Lymphat Disord. 2013;1(2):159–164. https://doi.org/10.1016/j.jvsv.2012.07.008.Sufian S., Arnez A., Labropoulos N., Lakhanpal S. Incidence, progression, and risk factors for endovenous heat-induced thrombosis after radiofrequency ablation. J Vasc Surg Venous Lymphat Disord. 2013;1(2):159–164. https://doi.org/10.1016/j.jvsv.2012.07.008.Hicks C.W., DiBrito S.R., Magruder J.T., Weaver M.L., Barenski C., Heller J.A. Radiofrequency ablation with concomitant stab phlebectomy increases risk of endovenous heat-induced thrombosis. J Vasc Surg Venous Lymphat Disord. 2017;5(2):200–209. https://doi.org/10.1016/j.jvsv.2016.10.081.Hicks C.W., DiBrito S.R., Magruder J.T., Weaver M.L., Barenski C., Heller J.A. Radiofrequency ablation with concomitant stab phlebectomy increases risk of endovenous heat-induced thrombosis. J Vasc Surg Venous Lymphat Disord. 2017;5(2):200–209. https://doi.org/10.1016/j.jvsv.2016.10.081.Lobastov K., Borsuk D., Fokin A., Shaldina M., Schastlivtsev I., Laberko L. Caprini Score in Venous Surgery: First Results From an Ongoing Registry Study. J Vasc Surg Venous Lymphat Disord. 2021;9(2):550–551. https://doi.org/10.1016/j.jvsv.2020.12.041.Lobastov K., Borsuk D., Fokin A., Shaldina M., Schastlivtsev I., Laberko L. Caprini Score in Venous Surgery: First Results From an Ongoing Registry Study. J Vasc Surg Venous Lymphat Disord. 2021;9(2):550–551. https://doi.org/10.1016/j.jvsv.2020.12.041.Бокерия Л.А., Затевахин И.И., Кириенко А.И., Андрияшкин А.В., Андрияшкин В.В., Арутюнов Г.П. и др. Российские клинические рекомендации по диагностике, лечению и профилактике венозных тромбоэмболических осложнений (ВТЭО). Флебология. 2015;9(4-2):1–51. Режим доступа: https://webmed.irkutsk.ru/doc/pdf/pe2015.pdf.Bokeria L.A., Zatevakhin I.I., Kirienko A.I., Andriyashkin A.V., Andriyashkin V.V., Arutyunov G.P. et al. Russian clinical guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications (VTEC). Flebologiya. 2015;9(4-2):1–51. (In Russ.) Available at: https://webmed.irkutsk.ru/doc/pdf/pe2015.pdf.Pence K., Fullin D., Kendall M.C., Apruzzese P., De Oliveira G. The association between surgical duration and venous thromboembolism in outpatient surgery: A propensity score adjusted prospective cohort study. Ann Med Surg (Lond). 2020;60:498–503. https://doi.org/10.1016/j.amsu.2020.11.003.Pence K., Fullin D., Kendall M.C., Apruzzese P., De Oliveira G. The association between surgical duration and venous thromboembolism in outpatient surgery: A propensity score adjusted prospective cohort study. Ann Med Surg (Lond). 2020;60:498–503. https://doi.org/10.1016/j.amsu.2020.11.003.Kemp M.T., Obi A.T., Henke P.K., Wakefield T.W. A narrative review on the epidemiology, prevention, and treatment of venous thromboembolic events in the context of chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1557–1567. https://doi.org/10.1016/j.jvsv.2021.03.018.Kemp M.T., Obi A.T., Henke P.K., Wakefield T.W. A narrative review on the epidemiology, prevention, and treatment of venous thromboembolic events in the context of chronic venous disease. J Vasc Surg Venous Lymphat Disord. 2021;9(6):1557–1567. https://doi.org/10.1016/j.jvsv.2021.03.018.Baylis R.A., Smith N.L., Klarin D., Fukaya E. Epidemiology and Genetics of Venous Thromboembolism and Chronic Venous Disease. Circ Res. 2021;128(12):1988–2002. https://doi.org/10.1161/circresaha.121.318322.Baylis R.A., Smith N.L., Klarin D., Fukaya E. Epidemiology and Genetics of Venous Thromboembolism and Chronic Venous Disease. Circ Res. 2021;128(12):1988–2002. https://doi.org/10.1161/circresaha.121.318322.Caron A., Depas N., Chazard E., Yelnik C., Jeanpierre E., Paris C. et al. Risk of Pulmonary Embolism More Than 6 Weeks After Surgery Among Cancer-Free Middle-aged Patients. JAMA Surgery. 2019;154(12):1126–1132. https://doi.org/10.1001/jamasurg.2019.3742.Caron A., Depas N., Chazard E., Yelnik C., Jeanpierre E., Paris C. et al. Risk of Pulmonary Embolism More Than 6 Weeks After Surgery Among Cancer-Free Middle-aged Patients. JAMA Surgery. 2019;154(12):1126–1132. https://doi.org/10.1001/jamasurg.2019.3742.Pandor A., Tonkins M., Goodacre S., Sworn K., Clowes M., Griffin X.L. et al. Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review. BMJ Open. 2021;11(7):e045672. https://doi.org/10.1136/bmjopen-2020-045672.Pandor A., Tonkins M., Goodacre S., Sworn K., Clowes M., Griffin X.L. et al. Risk assessment models for venous thromboembolism in hospitalised adult patients: a systematic review. BMJ Open. 2021;11(7):e045672. https://doi.org/10.1136/bmjopen-2020-045672.Rhee S.J., Cantelmo N.L., Conrad M.F., Stoughton J. Factors influencing the incidence of endovenous heat-induced thrombosis (EHIT). Vasc Endovascular Surg. 2013;47(3):207–212. https://doi.org/10.1177/1538574413478494.Rhee S.J., Cantelmo N.L., Conrad M.F., Stoughton J. Factors influencing the incidence of endovenous heat-induced thrombosis (EHIT). Vasc Endovascular Surg. 2013;47(3):207–212. https://doi.org/10.1177/1538574413478494.Wolkowski K., Wolkowski M., Urbanek T. Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery-Prospective Observational Study. J Clin Med. 2020;9(12):3970. https://doi.org/10.3390/jcm9123970.Wolkowski K., Wolkowski M., Urbanek T. Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery-Prospective Observational Study. J Clin Med. 2020;9(12):3970. https://doi.org/10.3390/jcm9123970.Grill M.H., Caffaro R.A., Grill T.A., Júnior V.C., Kikuchi R., Ribeiro C.M. et al. A Prospective Study Evaluating Patterns of Responses to the Caprini Score to Prevent Venous Thromboembolism After Interventional Treatment for Varicose Veins. Clin Appl Thromb Hemost. 2022;28:10760296221112081. https://doi.org/10.1177/10760296221112081.Grill M.H., Caffaro R.A., Grill T.A., Júnior V.C., Kikuchi R., Ribeiro C.M. et al. A Prospective Study Evaluating Patterns of Responses to the Caprini Score to Prevent Venous Thromboembolism After Interventional Treatment for Varicose Veins. Clin Appl Thromb Hemost. 2022;28:10760296221112081. https://doi.org/10.1177/10760296221112081.Gould M.K., Garcia D.A., Wren S.M., Karanicolas P.J., Arcelus J.I., Heit J.A., Samama C.M. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(Suppl. 2):e227S–e277S. https://doi.org/10.1378/chest.11-2297.Gould M.K., Garcia D.A., Wren S.M., Karanicolas P.J., Arcelus J.I., Heit J.A., Samama C.M. Prevention of VTE in nonorthopedic surgical patients: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(Suppl. 2):e227S–e277S. https://doi.org/10.1378/chest.11-2297.Стойко Ю.М., Кириенко А.И., Затевахин И.И., Покровский А.В., Карпенко А.А., Золотухин И.А. и др. Российские клинические рекомендации по диагностике и лечению хронических заболеваний вен. Флебология. 2018;(3):146–240. Режим доступа: https://www.mediasphera.ru/issues/flebologiya/2018/3/downloads/ru/1199769762018031146.Stoyko Yu.M., Kirienko A.I., Zatevakhin I.I., Pokrovsky A.V., Karpenko A.A., Zolotukhin I.A. et al. Russian Clinical Guidelines for the Diagnostics and Treatment of Chronic Venous Diseases. Flebologiya. 2018;12(3):146–240. (In Russ.) https://doi.org/10.17116/flebo20187031146.Камаев А.А., Булатов В.Л., Вахратьян П.Е., Волков А.М., Волков А.С., Гаврилов Е.К. и др. Варикозное расширение вен. Флебология. 2022;16(1):41–108. https://doi.org/10.17116/flebo20221601141.Kamaev A.A., Bulatov V.L., Vakhratyan P.E., Volkov A.M., Volkov A.S., Gavrilov E.K. et al. Varicose Veins. Flebologiya. 2022;16(1):41–108. (In Russ.) https://doi.org/10.17116/flebo20221601141.Kakkos S.K., Gohel M., Baekgaard N., Bauersachs R., Bellmunt-Montoya S., Black S.A. et al. Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.Kakkos S.K., Gohel M., Baekgaard N., Bauersachs R., Bellmunt-Montoya S., Black S.A. et al. Clinical Practice Guidelines on the Management of Venous Thrombosis. Eur J Vasc Endovasc Surg. 2021;61(1):9–82. https://doi.org/10.1016/j.ejvs.2020.09.023.Богачев В.Ю., Лобастов К.В., Фокин А.А., Шайдаков Е.В., Бурлева Е.П., Крылов А.Ю. и др. О текущей ситуации в отношении рисков и профилактики развития венозных тромбоэмболических осложнений после хирургического лечения варикозной болезни. Амбулаторная хирургия. 2022;19(1):157–160. https://doi.org/10.21518/1995-1477-2022-19-1-157-160.Bogachev V.Yu., Lobastov K.V., Fokin A.A., Shaydakov E.V., Burleva E.P., Krylov A.Yu. et al. About the current situation with regard to the risks and prevention of venous thromboembolic complications after varicose vein surgery. Ambulatornaya Khirurgiya. 2022;19(1):157–160. (In Russ.) https://doi.org/10.21518/1995-1477-2022-19-1-157-160.Moreira H., Sousa J., Mansilha A. Chemothromboprophylaxis in varicose vein surgery. A systematic review. Int Angiol. 2022;41(4):346–355. https://doi.org/10.23736/S0392-9590.22.04908-2.Moreira H., Sousa J., Mansilha A. Chemothromboprophylaxis in varicose vein surgery. A systematic review. Int Angiol. 2022;41(4):346–355. https://doi.org/10.23736/S0392-9590.22.04908-2.Wang H., Sun Z., Jiang W., Zhang Y., Li X., Wu Y. Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV). Vasc Med. 2015;20(2):117–121. https://doi.org/10.1177/1358863X14564592.Wang H., Sun Z., Jiang W., Zhang Y., Li X., Wu Y. Postoperative prophylaxis of venous thromboembolism (VTE) in patients undergoing high ligation and stripping of the great saphenous vein (GSV). Vasc Med. 2015;20(2):117–121. https://doi.org/10.1177/1358863X14564592.Warot M., Synowiec T., Wencel-Warot A., Daroszewski P., Bojar I., Micker M., Chęciński P. Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas? Ann Agric Environ Med. 2014;21(3):601–605. https://doi.org/10.5604/12321966.1120610.Warot M., Synowiec T., Wencel-Warot A., Daroszewski P., Bojar I., Micker M., Chęciński P. Can deep vein thrombosis be predicted after varicose vein operation in women in rural areas? Ann Agric Environ Med. 2014;21(3):601–605. https://doi.org/10.5604/12321966.1120610.San Norberto García E.M., Merino B., Taylor J.H., Vizcaíno I., Vaquero C. Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial. Ann Vasc Surg. 2013;27(7):940–946. https://doi.org/10.1016/j.avsg.2013.03.006.San Norberto García E.M., Merino B., Taylor J.H., Vizcaíno I., Vaquero C. Low-molecular-weight heparin for prevention of venous thromboembolism after varicose vein surgery in moderate-risk patients: a randomized, controlled trial. Ann Vasc Surg. 2013;27(7):940–946. https://doi.org/10.1016/j.avsg.2013.03.006.Gonzalez-Fregoso R., Leo-Amador G.E., Garcia-Gil L. Rivaroxaban for thromboprophylaxis after venous ablation with radiofrequency in the saphenous femoral and saphenous popliteal junction. Rev Mex Angiol. 2019;47(4):49–52. Available at: https://www.scielo.org.mx/pdf/rmang/v47n4/0377-4740-rma-47-4-49.pdf.Gonzalez-Fregoso R., Leo-Amador G.E., Garcia-Gil L. Rivaroxaban for thromboprophylaxis after venous ablation with radiofrequency in the saphenous femoral and saphenous popliteal junction. Rev Mex Angiol. 2019;47(4):49–52. Available at: https://www.scielo.org.mx/pdf/rmang/v47n4/0377-4740-rma-47-4-49.pdf.Nieto J.A., Espada N.G., Merino R.G., González T.C. Dabigatran, rivaroxaban and apixaban versus enoxaparin for thomboprophylaxis after total knee or hip arthroplasty: pool-analysis of phase III randomized clinical trials. Thromb Res. 2012;130(2):183–191. https://doi.org/10.1016/j.thromres.2012.02.011.Nieto J.A., Espada N.G., Merino R.G., González T.C. Dabigatran, rivaroxaban and apixaban versus enoxaparin for thomboprophylaxis after total knee or hip arthroplasty: pool-analysis of phase III randomized clinical trials. Thromb Res. 2012;130(2):183–191. https://doi.org/10.1016/j.thromres.2012.02.011.Samama C.M., Laporte S., Rosencher N., Girard P., Llau J., Mouret P. et al. Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery. N Engl J Med. 2020;382:1916–1925. https://doi.org/10.1056/NEJMoa1913808.Samama C.M., Laporte S., Rosencher N., Girard P., Llau J., Mouret P. et al. Rivaroxaban or Enoxaparin in Nonmajor Orthopedic Surgery. N Engl J Med. 2020;382:1916–1925. https://doi.org/10.1056/NEJMoa1913808.Uthoff H., Holtz D., Broz P., Staub D., Spinedi L. Rivaroxaban for thrombosis prophylaxis in endovenous laser ablation with and without phlebectomy. J Vasc Surg Venous Lymphat Disord. 2017;5(4):515–523. https://doi.org/10.1016/j.jvsv.2016.12.002.Uthoff H., Holtz D., Broz P., Staub D., Spinedi L. Rivaroxaban for thrombosis prophylaxis in endovenous laser ablation with and without phlebectomy. J Vasc Surg Venous Lymphat Disord. 2017;5(4):515–523. https://doi.org/10.1016/j.jvsv.2016.12.002.Keo H.H., Baumann F., Diehm N., Regli C., Staub D. Rivaroxaban versus fondaparinux for thromboprophylaxis after endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2017;5(6):817–823. https://doi.org/10.1016/j.jvsv.2017.04.017.Keo H.H., Baumann F., Diehm N., Regli C., Staub D. Rivaroxaban versus fondaparinux for thromboprophylaxis after endovenous laser ablation. J Vasc Surg Venous Lymphat Disord. 2017;5(6):817–823. https://doi.org/10.1016/j.jvsv.2017.04.017.Keo H.H., Spinedi L., Staub D., Diehm N., Holtz D., Broz P. et al. Duration of pharmacological thromboprophylaxis after outpatient endovenous laser ablation: a propensity score-matched analysis. Swiss Med Wkly. 2019;149:w20166. https://doi.org/10.4414/smw.2019.20166.Keo H.H., Spinedi L., Staub D., Diehm N., Holtz D., Broz P. et al. Duration of pharmacological thromboprophylaxis after outpatient endovenous laser ablation: a propensity score-matched analysis. Swiss Med Wkly. 2019;149:w20166. https://doi.org/10.4414/smw.2019.20166.Murzina E., Lobastov K., Laberko L., Dvornikov A., Popov I. Rivaroxaban for the prevention of venous thromboembolism after radiofrequency ablation of saphenous veins concomitant with miniphlebectomy, sclerotherapy, or no treatment of varicose tributaries. Phlebology. 2021;36(9):741–751. https://doi.org/10.1177/02683555211017336.Murzina E., Lobastov K., Laberko L., Dvornikov A., Popov I. Rivaroxaban for the prevention of venous thromboembolism after radiofrequency ablation of saphenous veins concomitant with miniphlebectomy, sclerotherapy, or no treatment of varicose tributaries. Phlebology. 2021;36(9):741–751. https://doi.org/10.1177/02683555211017336.Марцевич С.Ю., Навасардян А.Р., Комкова Н.А. Назначение лекарственных средств не в соответствии с официальной инструкцией по медицинскому применению (off-label). Возможные причины, виды и последствия. Правовое регулирование в Российской Федерации. Рациональная фармакотерапия в кардиологии. 2017;13(5):667–674. https://doi.org/10.20996/1819-6446-2017-13-5-667-674.Martsevich S.Yu., Navasardyan A.R., Komkova N.A. Off-label prescribing. Possible causes, types and consequences. Legal regulation in the Russian Federation. Rational Pharmacotherapy in Cardiology. 2017;13(5):667–674. (In Russ.) https://doi.org/10.20996/1819-6446-2017-13-5-667-674.Навасардян А.Р., Марцевич С.Ю., Габай П.Г. Назначение лекарственных препаратов не в соответствии с официальной инструкцией по медицинскому применению (off-label), клинические рекомендации, стандарты оказания медицинской помощи и правовое регулирование в Российской Федерации. Часть 2. Рациональная фармакотерапия в кардиологии. 2021;17(2):286–293. https://doi.org/10.20996/1819-6446-2021-04-01Navasardyan A.R., Martsevich S.Yu., Gabay P.G. Prescribing Drugs not in Accordance with the Official Instructions for Medical Use (Off-label), Clinical Guidelines, Standards of Medical Care and Legal Regulation in the Russian Federation. Part 2. Rational Pharmacotherapy in Cardiology. 2021;17(2):286–293. (In Russ.) https://doi.org/10.20996/1819-6446-2021-04-01.Boyle E., Reid J., O’Donnell M., Harkin D., Badger S. Thromboprophylaxis for varicose vein procedures – A national survey. Phlebology. 2019;34(9):598–603. https://doi.org/10.1177/0268355519828931.Boyle E., Reid J., O’Donnell M., Harkin D., Badger S. Thromboprophylaxis for varicose vein procedures – A national survey. Phlebology. 2019;34(9):598–603. https://doi.org/10.1177/0268355519828931.Keo H.H., Knoechel J., Spinedi L., Engelberger R.P., Staub D., Regli C. et al. Thromboprophylaxis practice after outpatient endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord. 2021;9(4):916–924. https://doi.org/10.1016/j.jvsv.2020.10.007.Keo H.H., Knoechel J., Spinedi L., Engelberger R.P., Staub D., Regli C. et al. Thromboprophylaxis practice after outpatient endovenous thermal ablation. J Vasc Surg Venous Lymphat Disord. 2021;9(4):916–924. https://doi.org/10.1016/j.jvsv.2020.10.007.

The authors declare that there are no conflicts of interest present.