Superficial Thrombophlebitis of the Legs: A Randomized, Controlled, Follow-up Study

Abstract

The aim of the present study was to evaluate the effects of different treatment plans (compression only, early surgery, low-dose subcutaneous heparin [LDSH], low-molecular-weight heparin [LMWH], and oral anticoagulant [OC] treatment) in the management of superficial thrombophlebitis (STP), by considering efficacy and costs in a 6-month, randomized, follow-up trial. Patients with STP, with large varicose veins without any suspected/documented systemic disorder, were included. Criteria for inclusion were as follows: presence of varicose veins; venous incompetence (by duplex); a tender, indurated cord along a superficial vein; and redness and heat in the affected area. All patients were ambulatory. Exclusion criteria were obesity, cardiovascular or neoplastic diseases, bone/joint disease, problems requiring immobilization, and age > 70 years. Patients with superficial thrombophlebitis without varicose veins and patients under treatment with drugs at referral were also excluded. Color duplex (CD) was used to detect concomitant deep vein thrombosis (DVT) and to evaluate the extension or reduction of STP at 3 and 6 months. Venography was not used. Of 562 patients included, 3.5% had had a recent DVT in the same limb affected by SVT and 2.1% in the contralateral limb. In six patients DVT was present in both limbs. These patients were treated with anticoagulants and excluded from the follow-up. After 3 and 6 months the incidence of STP extension was higher in the elastic compression and in the saphenous ligation groups (p < 0.05). There was no significant difference in DVT incidence at 3 months among the treatment groups. Stripping of the affected veins was associated with the lowest incidence of thrombus extension. The cost for compression alone was the lowest and the cost including LMWH was the highest. The average cost was 1,383 US$. However the highest social cost (lost working days, inactivity) was observed in subjects treated only with stockings.

Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs

“…[8][9][10][11][12][13][14] The few randomized studies that have been performed did not clarify the circumstances under which surgery is required or the value or optimal dose and duration of anticoagulant or antiinflammatory therapy. 6,[15][16][17][18][19] The results of the two largest studies, evaluating low-molecular-weight heparin, suggest that high-dose (therapeutic) or intermediate-dose regimens do not provide substantial benefits over low-dose (prophylactic) regimens and that a treatment period of 12 days or of 30 days is too short, with most symptomatic thromboembolic complications occurring after the treatment period. 6,17 None of the published studies showed a clinically relevant bene fit of any treatment as compared with placebo.…”

Clinical Features and Developing Risks of Saphenous Vein Thrombophlebitis

“…1,[8][9][10][11][12] With one exception (case 12 with lung cancer), all patients in this study underwent surgery to prevent extension of the saphenous thrombus to a deep vein. Four cases underwent surgery after anticoagulation therapy.…”

Prevalence of Isolated Asymptomatic Deep Vein Thrombosis in Varicose Vein Patients with Superficial Thrombophlebitis: A Single Center Experience in Japan

“…Belcaro et al, from an English and Italian group, conducted an RCT study to evaluate the effects of several STP management plans on progression of the STP and the incidence of concomitant DVT at 3-months follow-up. 16) They demonstrated that among several treatments: 1) ECS alone, 2) low dose subcutaneous heparin, 3) LMWH, 4) simple flush ligation of the saphenous vein, 5) stripping of affected veins, the incidence of STP extension was significantly higher in the group with 1) ECS, and 4) high ligation. They also showed that there was no significant difference in DVT incidence at 3-months follow-up among these treatment groups.…”