Advertisement

Management of Superficial Venous Thrombosis

September 11, 2013

Management of Superficial Venous Thrombosis

  1. David Green, MD, PhD

Nearly 10% of untreated patients experienced symptomatic SVT extension.

  1. David Green, MD, PhD

Thrombi often arise in the superficial veins of the leg. Those forming near the saphenofemoral junction (SFJ) are treated by saphenous vein ligation, thrombectomy, or anticoagulation. But whether superficial vein thrombosis (SVT) distal to the SFJ requires more than analgesics and local measures has been controversial.

To examine the frequency of thrombus extension, deep vein thrombosis (DVT), and pulmonary embolism (PE) in patients with SVT who do not receive anticoagulants, investigators analyzed data from the industry-sponsored, placebo-controlled CALISTO trial (N Engl J Med 2010; 363:1222). In that study, 3002 patients were randomized to receive placebo or the synthetic low-molecular-weight heparin fondaparinux (2.5 mg subcutaneously per day) and were followed for up to 77 days.

Symptomatic extension of the index SVT occurred in 9.4% of placebo patients, of whom 6.4% had DVT and 2.7% had PE; proximity of the thrombus to the SFJ was unrelated to the incidence of DVT or PE. In contrast, only 1.9% of fondaparinux recipients developed SVT extension (relative risk, 0.21; P<0.001), and none developed DVT or PE. Fondaparinux recipients also used fewer healthcare resources, such as inpatient and outpatient visits, surgical treatment of the SVT, and therapeutic-dose anticoagulants.

Comment

This large study demonstrates that nearly 1 in 10 patients with superficial vein thrombosis who were not treated with anticoagulants progressed to more-extensive venous thrombosis. These findings take on added significance when considering that patients with active cancer (symptomatic within the preceding 6 months) were excluded from the trial and that SVT is common in such patients. Whether low-dose anticoagulant therapy will be safe and effective for SVT in patients with active cancer needs to be examined by future studies.

  • Disclosures for David Green, MD, PhD at time of publication Consultant / Advisory board Altor Bioscience Grant / research support NIH

Citation(s):

Your Comment

(will not be published)

Filtered HTML

  • Allowed HTML tags: <a> <em> <strong> <cite> <blockquote> <code> <ul> <ol> <li> <dl> <dt> <dd>
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

Plain text

  • No HTML tags allowed.
  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.
Do you have any conflict of interest to disclose?
CAPTCHA
This question is for testing whether you are a human visitor and to prevent automated spam submissions.
Image CAPTCHA
Enter the characters shown in the image.

Vertical Tabs

* Required

Reader comments are intended to encourage lively discussion of clinical topics with your peers in the medical community. We ask that you keep your remarks to a reasonable length, and we reserve the right to withhold publication of remarks that do not meet this standard.

PRIVACY: We will not use your email address, submitted for a comment, for any other purpose nor sell, rent, or share your e-mail address with any third parties. Please see our Privacy Policy.

Advertisement
Advertisement
Advertisement