Usefulness of Anticoagulation in Superficial Vein Thrombi
Date First Published:
July 21, 2016
Last Updated:
October 5, 2016
Report by:
Shivani H. Patel, Senior resident physician (Grand Rapids Medical Education Research Partners/Michigan State University)
Search checked by:
Bryan Judge MD, Grand Rapids Medical Education Research Partners/Michigan State University
Three-Part Question:
In [adults with thrombi in their superficial veins of the lower extremity], does [anticoagulation] lead to [improved outcomes and fewer complications]?
Clinical Scenario:
A 61-year-old lady presents to the ED with redness and swelling around a varicose vein that extends from the lateral aspect of the left knee to the mid-portion of the lateral aspect of the left leg. She has a 25-year history of asymptomatic lower extremity varicosities which appeared after the birth of her first child. A duplex ultrasound confirms your clinical diagnosis of "superficial thrombophlebitis". You begin treatment with a nonsteroidal anti-inflammatory drug (NSAID), compression stockings and arrange follow-up in 2-3 days. Although she has no risk factors for hypercoagulability or deep venous thrombosis, you wonder if anticoagulants might reduce complications.
Search Strategy:
Medline 1966-04/16 using OVID interface, Cochrane Library (2016), and Embase
Search Details:
[(exp superficial phlebitis/ or exp superficial thrombophlebitis/ or exp superficial vein thrombosis/) AND (exp Heparin, low molecular weight / or exp anticoagulants/ or exp coumarin/ or exp fondaparinux/)]. Limit to English language.
Outcome:
68 studies were identified; one meta-analysis addressed the clinical question. This review, published in 2013, considered 30 randomized controlled trials. There have been no additional RCTs published which relate to the clinical question.
Relevant Paper(s):
| Study Title | Patient Group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
|---|---|---|---|---|---|
| Treatment for superficial thrombophlebitis of the leg (Review) Di Nisio M et al 2013 Italy | 6462 participants with superficial thrombophlebitis to leg | Meta-analysis | Fondaparinux vs placebo | DVT and PE RR= 0.15 | Only a minority of trials compared treatment with placebo rather than an alternative treatment, none evaluated the same treatment comparisons on the same study outcomes (which precluded meta-analysis), and many of the studies were small and of poor quality. The randomization sequence was adequately generated in only 11 studies. Twelve studies did not attempt to blind the assessment of the outcomes or did not report whether blinding was used or not. |
| Fondaparinux vs placebo | Extension of ST RR= 0.08 | ||||
| Fondaparinux vs placebo | Mortality RR=2.0 | ||||
| Fondaparinux vs placebo | Any Adverse event RR 0.97 | ||||
| Prophylactic LMWH vs placebo | Extension and/or recurrence of ST RR=0.44 | ||||
| Prophylactic LMWH vs placebo | Venous thromboembolism 3-month follow up RR=1.22 | ||||
| Therapeutic LMWH vs Placebo | Extension and/or recurrence of ST RR=0.46 | ||||
| Theraoeutic LMWH vs placebo | venous thromboembolism 3-month follow up RR 0.85 | ||||
| Fondaparinux vs placebo | Recurrence of ST RR 0.21 |
Author Commentary:
Traditionally, superficial thrombophlebitis treatment has varied. Improving local symptoms is important, but the prevention of a venous thromboembolism and reduction in ST progression is important. Multiple treatment options exist, including fondaparinux, low-molecular weight heparin, unfractionated heparin, non-steroidal anti-inflammatory agents and topical treatments.
Bottom Line:
The use of prophylactic fondaparinux for 45 days is a therapeutic option for superficial thrombophlebitis of the leg to help prevent symptomatic ST and reduce ST extension and recurrence.
References:
- Di Nisio M et al. Treatment for superficial thrombophlebitis of the leg (Review)