Scott M. Stevens, MD
What are the efficacy and safety of treatments for superficial thrombophlebitis (ST) of the leg?
Included studies compared topical, medical, and surgical treatments for ST of the leg with placebo, another treatment, or no treatment in patients diagnosed on the basis of signs and symptoms, clinical examination, and ultrasonography of the lower limbs. Exclusion criteria included concomitant deep venous thrombosis (DVT) identified on ultrasonography. Outcomes included objectively confirmed symptomatic pulmonary embolism (PE) or DVT, extension or recurrence of ST, and treatment side effects. Symptoms were not reported consistently and are not reported in this abstract.
Cochrane Peripheral Vascular Diseases Group Specialised Register, which includes search results from MEDLINE, EMBASE/Excerpta Medica, CINAHL, and AMED databases and hand-searches of journals (to Nov 2011); Cochrane Central Register of Controlled Trials (2011, Issue 4); conference proceedings; and reference lists were searched for randomized controlled trials (RCTs). Experts were contacted. 26 RCTs (n = 5521, mean age range 39 to 63 y, 43% to 79% women) met inclusion criteria and evaluated ≥ 1 treatment type: 11 evaluated low-molecular-weight heparin (LMWH) (n = 1651); 8 oral, intramuscular, or IV treatments (n = 1139); 7 topical agents (n = 296); 5 nonsteroidal antiinflammatory drugs (NSAIDs) (n = 710); 3 surgery (n = 705); and 1 fondaparinux (n = 3002). 3 RCTs had adequate allocation concealment, 14 used a double-blind design, and 7 did intention-to-treat analyses.
The main results for fondaparinux and LMWH are in the Table. Limited data were reported for other treatment comparisons.
In patients with superficial thrombophlebitis of the leg, prophylactic doses of fondaparinux reduce venous thromboembolism and extension or recurrence of disease without evidence of increasing major bleeding. Insufficient high-quality evidence exists to evaluate the effect of low-molecular-weight heparin or other treatments on patient-important outcomes.
Treatments for superficial thrombophlebitis (ST) of the leg*
*DVT = deep venous thrombosis; ECS = elastic compression stocking; LMWH = low-molecular-weight heparin; NR = not reported; PE = pulmonary embolism; RCT = randomized controlled trial; UFH = unfractionated heparin; VTE = venous thromboembolism; other abbreviations defined in Glossary.
†Comparisons included placebo, ECSs, nonsteroidal antiinflammatory drugs, defibrotide, venoruton, topical heparin spray gel, surgery, or different heparin doses.
Stevens SM. Review: Fondaparinux reduces VTE and recurrence in superficial thrombophlebitis of the leg. Ann Intern Med. 2012;157:JC2–4. doi: 10.7326/0003-4819-157-4-201208210-02004
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Published: Ann Intern Med. 2012;157(4):JC2-4.
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