Anticoagulation for Superficial Venous Thrombosis
By Dr. Tim Scheel
Brief patient presentation
49 yo male with pain and swelling to the lower extremity after a long drive from Arkansas.
Clinical question – PICO
In patients with superficial venous thrombosis that are high risk for propagation and progression to PE does anticoagulation improve outcomes when compared to patient’s who are treated with traditional NSAID therapy?
Available research – list references
Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database of Systematic Reviews 2013, Issue 4. Art. No.: CD004982. DOI: 10.1002/14651858.CD004982.pub5. (Level I)
Decousus, H., Prandoni, P., Mismetti, P., Bauersachs, R. M., Boda, Z., Brenner, B., … Leizorovicz, A. (2010). Fondaparinux for the treatment of superficial-vein thrombosis in the legs. New England Journal of Medicine, 363(13), 1222–1232. doi:10.1056/nejmoa0912072 (Level II)
Beyer-Westendorf, J., Schellong, S. M., Gerlach, H., Rabe, E., Weitz, J., Jersemann, K., . . . Bauersachs, R. (2017). Prevention of thromboembolic complications in patients with superficial-venous thrombosis given rivaroxaban or fondaparinux. Lancet Haematol 2017. http://dx.doi.org/10.1016/S2352-3026(17)30013-3 (Level II)
Does the literature in your search answer the question? Yes, in patient’s with high risk SVT, treatment with anticoagulation does improve outcomes when compared to patient’s treated with traditional NSAID therapy.
How will you proceed the next time this problem is encountered?
In the future I think this is evidence that will change my practice. SVT requires careful assessment of location and size of clot to evaluate for possible treatment with anticoagulants.