Efficacy and safety of short-term rivaroxaban prophylaxis after radiofrequency ablation for varicose veins: A single-centre randomised controlled trial

Objective Lower extremity varicose veins are a common chronic venous disorder, affecting approximately 23% of adults globally. Although endovenous thermal ablation, particularly radiofrequency ablation (RFA), has become the preferred treatment, post-procedural deep vein thrombosis (DVT) remains a concern. The necessity of pharmacologic prophylaxis following RFA remains controversial. This study aimed to assess the efficacy and safety of short-term prophylactic rivaroxaban for DVT prevention after RFA. Methods In this single-centre, randomized controlled trial, patients with lower extremity varicose veins undergoing RFA, with or without Trivex-assisted phlebectomy, were recruited between August 2020 and December 2024. Participants were randomized to receive either rivaroxaban (10 mg daily for 5 days postoperatively) or standard preventive care including early ambulation and compression. All patients were followed for 1 month, with DVT incidence evaluated by B-mode ultrasonography. Results A total of 298 patients were enrolled. No DVT events occurred in the rivaroxaban group, while four cases (2.7%) were observed in the standard care group ( p = .04). No major bleeding events were reported. Minor bleeding occurred in 4.7% of the rivaroxaban group and 2.7% of the control group ( p = .35). Conclusions Short-term prophylactic rivaroxaban significantly reduced DVT risk following RFA, with no significant increase in bleeding complications. These findings support its potential role in optimising perioperative thromboprophylaxis for varicose vein patients undergoing thermal ablation.