Treatment

The treatment of superficial thrombophlebitis can be controversial:

Treatment options include: (1)

• gentle support by means of a bandage or stocking and elevation of the affected leg
• anti-inflammatory drugs such as ibuprofen 400mg t.d.s
• topical measures include treatment with preparations such Hirudoid
• use of low molecular weight heparin

In patients with a high risk of thrombus progression into the deep venous system and embolisation, anticoagulation is recommended to prevent thrombus extension, thromboembolic complications, and recurrence. (1)

Therapeutic strategies must include symptomatic relief, limitation of thrombosis extension, and, very importantly, reduction of the risk of pulmonary embolism (2):

• in cases of limited (below knee) superficial thrombophlebitis without evidence of deep vein thrombosis, compression and non-steroidal anti-inflammatory drugs alone will suffice by providing symptomatic relief
  
  
• if thrombus extends to the sapheno-femoral or sapheno-popliteal junctions prophylactic use of low molecular weight heparin may be indicated. Surgical intervention is a controversial option if anticoagulation is contraindicated or not tolerated, but it may compound the risk of venous thromboembolism.

Notes (3,4):

Patients with superficial thrombophlebitis may have an underlying DVT. For this reason one should consider a duplex ultrasound scan in patients with superficial thrombophlebitis which follows the course of the long saphenous vein in the leg.

• prevalence of associated acute DVT in patients presenting with SVT is estimated to 6.8%-40%
  • reason for the range of associated acute DVT is because of the wide variation in study design, patient characteristics, symptomatic status, type of SVT, inpatient versus outpatient setting, indications, and whether or not any non invasive testing was performed.
  • a study based on outpatients diagnosed with SVT (4)
    • the incidence of acute DVT was 13%
    • however, the incidence varied from 6.3% in patients with varicose veins, 33% in patients without varicose veins, and 40% in patients with a previous history of DVT
• risk of pulmonary embolism
  • the occurrence of concomitant pulmonary embolism is also variable, from 0.5% to 4% in symptomatic patients, increasing to 33% when a lung scan is performed (4)

Prophylactic anticoagulation is recommended for all patients with a superficial thrombus ≥5 cm in length within the great saphenous (GSV), small saphenous (SSV), or anterior accessory great saphenous (AASV) veins and >3 cm from the sapheno-femoral or sapheno-popliteal junctions (5).

Guidelines recommend 45 days of anticoagulation, with prophylactic doses of fondaparinux as the preferred option (5)

Reference:

1. Kakkos SK, Gohel M, Baekgaard N, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2021 clinical practice guidelines on the management of venous thrombosis. Eur J Vasc Endovasc Surg. 2021 Jan;61(1):9-82.
2. Nasr H, Scriven JM..Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015 Jun 22;350:h2039.
3. Litzendorf ME1, Satiani B. Superficial venous thrombosis: disease progression and evolving treatment approaches.Vasc Health Risk Manag. 2011;7:569-75.
4. Gorty S, Patton-Adkins J, Dalanno M, Starr JE, Dean S, Satiani B. Superficial venous thrombosis of the lower extremities: Analysis of risk factors, and recurrence and role of anticoagulation. Vasc Med. 2004;9:1-6
5. Twine CP, Kakkos SK, Aboyans V, et al. Editor's choice - European Society for Vascular Surgery (ESVS) 2023 clinical practice guidelines on antithrombotic therapy for vascular diseases. Eur J Vasc Endovasc Surg. 2023 May;65(5):627-89.