Controversies in venous thromboembolism: to treat or not to treat superficial vein thrombosis

Abstract

The management of superficial vein thrombosis (SVT) is poorly defined and remains controversial overall. SVT has long been considered a benign, self-limited disease, but recent studies show that SVT carries a nonnegligible risk for recurrence, deep vein thrombosis, or pulmonary embolism. Current guidelines recommend the use of low-molecular-weight heparin or fondaparinux, but results of several surveys indicate that the majority of patients with SVT receive nonanticoagulant therapy only, which includes compression stockings or bandages, nonsteroidal anti-inflammatory drugs, topical application of heparin gel, or surgical interventions. However, several recent observational and interventional studies provide better insight into the optimal treatment of patients with SVT who are at different risks for thromboembolic complications. This educational review summarizes the available evidence and aims to provide practical guidance based on a clinical decision pathway.

Antithrombotic Therapy for VTE Disease

“…SVT has been less well studied than DVT but is estimated to occur more often. 189 It usually affects the lower limbs; often involves a varicose vein; and is associated with chronic venous insufficiency, malignancy, thrombophilia, pregnancy or estrogen therapy, obesity, sclerotherapy, long-distance travel, and a history of VTE. In addition, SVT may be unprovoked.…”

Executive Summary

“…22 2018 National Comprehensive Cancer Network guideline: Indicates that LMWH is the preferred agent for the first six months in patients with CAT. Comments: SVT has been less well studied than DVT, likely occurs more often, 26 and usually affects the lower limbs. Although historically considered a benign disease, more recent appreciation of the seriousness of SVT has informed treatment studies.…”

Medicine and Phlebolymphology: Time to Change?

“…Therapy with DOAC in SVT represents a controversial indication [ 103 ], and probably further studies should corroborate this approach, in opposition to the validated protocol with LMWH and compression. Stratification of SVT patients as to risk factors would probably benefit treatment selection, preferring DOAC only in higher VTE risk patients [ 44 , 104 ]. Overall, in the last decades, an extremely large number of studies have addressed DOAC and LMWH employment, mostly thanks to the impulse coming from the industries, with new pharmaceutic products overriding one over another.…”