Treatment for superficial thrombophlebitis of the leg
- PMID: 22419302
- DOI: 10.1002/14651858.CD004982.pub4
Treatment for superficial thrombophlebitis of the leg
Update in
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Treatment for superficial thrombophlebitis of the leg.Cochrane Database Syst Rev. 2013 Apr 30;(4):CD004982. doi: 10.1002/14651858.CD004982.pub5. Cochrane Database Syst Rev. 2013. Update in: Cochrane Database Syst Rev. 2018 Feb 25;2:CD004982. doi: 10.1002/14651858.CD004982.pub6. PMID: 23633322 Updated.
Abstract
Background: The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is an update of a review first published in 2007.
Objectives: To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of the legs.
Search methods: For this update the Cochrane Peripheral Vascular Diseases Group searched their Specialised Register (last searched 29 November 2011) and CENTRAL (2011, Issue 4). We handsearched reference lists of relevant papers and conference proceedings.
Selection criteria: Randomised controlled trials (RCTs) evaluating topical, medical, and surgical treatments for ST of the leg that included participants with a clinical diagnosis of ST of the legs or objective diagnosis of a thrombus in the superficial vein.
Data collection and analysis: Two authors assessed the trials for inclusion in the review, extracted the data, and assessed the quality of the studies. Data were independently extracted from the included studies and any disagreements resolved by consensus.
Main results: Twenty-six studies involving 5521 participants with ST of the legs were included in this review. The methodological quality of most of the trials was poor. Treatment ranged from fondaparinux, low molecular weight heparin (LMWH), unfractionated heparin (UFH), non-steroidal anti-inflammatory agents (NSAIDs), topical treatment, oral treatment, intramuscular treatment, and intravenous treatment to surgery. In a placebo-controlled RCT of about 3000 patients, fondaparinux was associated with a significant reduction in symptomatic VTE (RR 0.15; 95% CI 0.04 to 0.50), extension (RR 0.08; 95% CI 0.03 to 0.22), and recurrence of ST (RR 0.21; 95% CI 0.08 to 0.54) with comparable rates of major bleeding (RR 0.99; 95% CI 0.06 to 15.86) relative to placebo. Both prophylactic and therapeutic doses of LMWH (RR 0.40; 95% CI 0.22 to 0.72 and RR 0.42; 95% CI 0.23 to 0.75, respectively) and NSAIDs (RR 0.41; 95% CI 0.23 to 0.75) reduced the extension and recurrence of ST in comparison to placebo, with no significant effects on symptomatic VTE nor major bleeding. Overall, topical treatments improved local symptoms. However, no data were provided on the effects of these treatments on VTE and ST extension. Surgical treatment combined with elastic stockings in ST was associated with a lower VTE rate and ST progression compared with elastic stockings alone.
Authors' conclusions: Prophylactic dose fondaparinux given for six weeks appears to be a valid therapeutic option for ST of the legs. Further research is needed to assess the role of new oral direct thrombin and activated factor-X inhibitors, LMWH, NSAIDs; the optimal doses and duration of treatment; and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments.
Update of
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Treatment for superficial thrombophlebitis of the leg.Cochrane Database Syst Rev. 2007 Apr 18;(2):CD004982. doi: 10.1002/14651858.CD004982.pub3. Cochrane Database Syst Rev. 2007. Update in: Cochrane Database Syst Rev. 2012 Mar 14;(3):CD004982. doi: 10.1002/14651858.CD004982.pub4. PMID: 17443561 Updated.
Comment in
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Prophylactic dose fondaparinux for 6 weeks in superficial thrombophlebitis of the legs reduces the risk for symptomatic thromboembolic complications.Evid Based Med. 2013 Feb;18(1):28-9. doi: 10.1136/eb-2012-100755. Epub 2012 Jun 27. Evid Based Med. 2013. PMID: 22740355 No abstract available.
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ACP Journal Club: review: fondaparinux reduces VTE and recurrence in superficial thrombophlebitis of the leg.Ann Intern Med. 2012 Aug 21;157(4):JC2-4. doi: 10.7326/0003-4819-157-4-201208210-02004. Ann Intern Med. 2012. PMID: 22910958 No abstract available.
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