Pathogenesis, diagnosis, and treatment of endothermal heat-induced thrombosis (EHIT)

Propagation of a thrombus from a superficial vein into a deeper vein post endovenous thermal ablation is called endothermal heat-induced thrombosis (EHIT). It is generally considered clinically insignificant if the thrombus does not propagate to the deep venous system. Diagnosis of EHIT is based mainly on 4 classification categories for both saphenofemoral junction and saphenopopliteal junction. The condition can be treated with antiplatelet or anticoagulation therapy, although monitoring may be sufficient, especially in less-severe cases. Rivaroxaban may be a promising alternative for treatment of severe EHIT because the dosage regimen is simplified without compromising efficacy or safety and is easily available as an oral anticoagulant and is more cost-effective than perenteral enoxaparin. Prospective, randomized, controlled studies are needed to better understand EHIT and to develop more definitive recommendations on prevention and treatment options for this condition. Therefore, the true clinical significance of EHIT is still being determined.