Treatment for superficial thrombophlebitis of the leg

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Treatment for superficial thrombophlebitis of the leg

Di Nisio M, Wichers IM, Middeldorp S


Superficial thrombophlebitis (ST) is a relatively common inflammatory process associated with a blood clot (thrombus) that affects the superficial veins (veins that are close to the surface of the body). Symptoms and signs include local pain, itching, tenderness, reddening of the skin, and hardening of the surrounding tissue. There is some evidence to suggest a link between ST and venous thromboembolism (VTE; a condition where blood clots form (most often) in the deep veins of the leg and can travel in the circulation and lodge in the lungs). Treatment aims to relieve the local symptoms and to prevent the extension of the clot into a deep vein, ST recurrence, or the development of more serious events caused by VTE. This is the third update of a review first published in 2007. The evidence is current to March 2017.

Study characteristics and key results

This update included 33 randomised controlled trials (clinical trials where people are randomly put into one of two or more treatment groups) involving 7296 participants. Treatments included rivaroxaban (a medicine called a direct oral inhibitor of activated factor X), injections of medicines under the skin to prevent blood clotting (e.g. fondaparinux, low molecular weight heparin, or unfractionated heparin), elastic compression stockings, oral non-steroidal anti-inflammatory drugs (NSAIDs; a pain killer medicine), topical treatment (medicine applied to the skin), and surgery.

One large study, accounting for half of the participants included in the review, showed that treatment with fondaparinux for 45 days was associated with a significant reduction in symptomatic VTE (where symptoms indicate there is a VTE), ST extension (where the clot moves further up the leg), and recurrence of ST (where clots return) compared to placebo. Major bleeding was infrequent in both groups. In one study in people with ST at high risk of recurrent thromboembolic events, fondaparinux was associated with a non-significant reduction of symptomatic VTE compared to rivaroxaban. There were no major bleeding events in either group. Both low molecular weight heparin and NSAIDs reduced the occurrence of extension or recurrence of ST with no effect on symptomatic VTE or major bleeding. Topical treatments relieved local symptoms but the trials did not report on progression to VTE. Surgical treatment and wearing elastic stockings were associated with a lower rate of VTE and progression of the ST compared with elastic stockings alone.

Quality of the evidence

Overall, the quality of evidence was very low for most treatments due to poor study design, imprecision of results, lack of a placebo (non-treated) group and only one study in some comparison. The quality of evidence was low to moderate for comparisons in two placebo-controlled trials.

In conclusion, fondaparinux appears to be an adequate treatment for most people with ST. The optimal dose and duration of treatment need to be established in people at high risk as well as people at low risk for recurrent thrombotic events. Further research is needed to assess the role of rivaroxaban and other such medicines, or thrombin, low molecular weight heparin or NSAIDs and to demonstrate the effectiveness, if any, of topical treatment, or surgery in terms of VTE.

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