Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura

Walter Junior Boim de Araujo; Jorge Rufino Ribas Timi; Fabiano Luiz Erzinger; Filipe Carlos Caron

doi:10.1590/1677-5449.009816

Case Report

Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura

Endothermal heat-induced thrombosis (EHIT): reports on two case treated with rivaroxaban and literature review

Walter Junior Boim de Araujo; Jorge Rufino Ribas Timi; Fabiano Luiz Erzinger; Filipe Carlos Caron

http://dx.doi.org/10.1590/1677-5449.009816 J Vasc Bras, vol.15, n2, p.147-152, 2016

PDF

Downloads: 0

Resumo

Resumo Define-se trombose induzida pelo calor endovenoso como a propagação do trombo a partir de uma veia superficial em direção a uma veia mais profunda. Em geral, é considerada clinicamente insignificante quando não há propagação do trombo para o sistema venoso profundo. Essa condição pode ser tratada com terapia anticoagulante, embora a observação pareça ser suficiente, principalmente para graus menores. Neste estudo, relatamos dois casos de trombose induzida pelo calor endovenoso que teriam indicação de heparina de baixo peso molecular até a resolução do quadro. Porém, optou-se pelo uso da rivaroxabana (15 mg de 12 em 12h), com resolução completa do trombo em 4 semanas (caso 1) e em 7 dias (caso 2). A rivaroxabana pode ser uma alternativa promissora no tratamento da trombose induzida pelo calor endovenoso avançada, pela simplicidade da posologia, sem comprometimento da eficácia ou da segurança. São necessários estudos prospectivos, randomizados e controlados que possibilitem melhor entendimento da condição e o desenvolvimento de recomendações mais definitivas sobre opções de prevenção e tratamento.

Palavras-chave

varizes, laser endovenoso, ecografia vascular, trombose venosa

Abstract

Abstract Endothermal heat-induced thrombosis (EHIT) is defined as propagation of a thrombus from a superficial vein into a deeper vein and is generally considered clinically insignificant if the thrombus does not propagate to the deep venous system. The condition can be treated with anticoagulation therapy, although monitoring may be sufficient, especially in less severe cases. In this paper we report on two cases of EHIT that met the criteria for indication of low molecular weight heparin until resolution of symptoms. However, the treatment actually chosen was 15 mg of rivaroxaban every 12 h and the outcomes were complete thrombus resolution in 4 weeks in Case 1 and 7 days in Case 2. Rivaroxaban may be a promising alternative for treatment of severe EHIT because the dosage regimen is simplified without compromising efficacy or safety. Prospective, randomized, controlled studies are needed to better understand EHIT and to develop more definitive recommendations on prevention and treatment options for this condition.

Keywords

varicose veins, intravenous laser treatment, vascular ultrasonography, venous thrombosis

References

Min RJ, Khilnani N, Zimmet SE. Endovenous laser treatment of saphenous vein reflux: long-term results. J Vasc Interv Radiol. 2003;14(8):991-6.

Proebstle TM, Lehr HA, Kargl A. Endovenous treatment of the greater saphenous vein with a 940-nm diode laser: thrombotic occlusion after endoluminal thermal damage by laser-generated steam bubbles. J Vasc Surg. 2002;35(4):729-36.

Kane K, Fisher T, Bennett M. The incidence and outcome of endothermal heat-induced thrombosis after endovenous laser ablation. Ann Vasc Surg. 2014;28(7):1744-50.

Gonsalves WI, Pruthi RK, Patnaik MM. The new oral anticoagulants in clinical practice. Mayo Clin Proc. 2013;88(5):495-511.

Kabnick LS, Berland TL. Endovenous heat induced thrombosis (EHIT). 2011.

Rhee SJ, Stoughton J, Cantelmo NL. Procedural factors influencing the incidence of endovenous heat-induced thrombus (EHIT). J Vasc Surg. 2011;53(2):555.

Sadek M, Kabnick LS, Rockman CB. Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis. J Vasc Surg. 2013;1(3):257-62.

Kabnick LS, Ombrellino M, Agis H. Endovenous heat induced thrombosis (EHIT) at the superficial deep venous junction: a new post-treatment clinical entity, classification and potential treatment strategies. 2006.

Lawrence PF, Chandra A, Wu M. Classification of proximal endovenous closure levels and treatment algorithm. J Vasc Surg. 2010;52(2):388-93.

Harlander-Locke M, Jimenez JC, Lawrence PF. Management of endovenous heat-induced thrombus using a classification system and treatment algorithm following segmental thermal ablation of the small saphenous vein. J Vasc Surg. 2013;58(2):427-31.

Harlander-Locke M, Jimenez JC, Lawrence PF, Derubertis BG, Rigberg DA, Gelabert HA. Endovenous ablation with concomitant phlebectomy is a safe and effective method of treatment for symptomatic patients with axial reflux and large incompetent tributaries. J Vasc Surg. 2013;58(1):166-72.

Geerts WH, Bergqvist D, Pineo GF. Prevention of venous thromboembolism: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6^sSupl):381S-453S.

Bahl V, Hu HM, Henke PK, Wakefield TW, Campbell Jr DA, Caprini JA. A validation study of a retrospective venous thromboembolism risk scoring method. Ann Surg. 2010;251(2):344-50.

Sufian S, Arnez A, Labropoulos N, Lakhanpal S. Endovenous heat-induced thrombosis after ablation with 1470 nm laser: Incidence, progression, and risk factors. Phlebology. 2015;30(5):325-30.

Rosales-Velderrain A, Gloviczki P, Said SM, Hernandez MT, Canton LG, Kalra M. Pulmonary embolism after endovenous thermal ablation of the saphenous vein. Semin Vasc Surg. 2013;26(1):14-22.

Turpie AG, Lassen MR, Davidson BL. Rivaroxaban versus enoxaparin for thromboprophylaxis after total knee arthroplasty (RECORD4): a randomised trial. Lancet. 2009;373(9676):1673-80.

Bauersachs R, Berkowitz SD, Brenner B. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-510.

Werth S, Halbritter K, Mahlmann A, Weiss N. Treatment of an endovenous heat-induced thrombosis (EHIT) with rivaroxaban (Xarelto®). Phlebologie. 2015;44(4):184-7.

Gloviczki P, Comerota AJ, Dalsing MC. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5^sSupl):2S-48S.

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">

Trombose induzida pelo calor endovenoso: relato de dois casos tratados com rivaroxabana e revisão da literatura

Endothermal heat-induced thrombosis (EHIT): reports on two case treated with rivaroxaban and literature review

Walter Junior Boim de Araujo; Jorge Rufino Ribas Timi; Fabiano Luiz Erzinger; Filipe Carlos Caron

Resumo

Palavras-chave

Abstract

Keywords

References

Links

Share

J Vasc Bras