Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis

Abstract

Background The optimal first line treatment for patients with isolated superficial venous thrombosis (SVT) of the lower extremity is unknown. Objective This article reports estimates of the rate of venous thromboembolic complications among patients with SVT according to treatment. Materials and Methods A systematic review and meta-analysis was performed using unrestricted searches of electronic databases. Reported events were transformed to event per 100 patient-years of follow-up and a random effects model was used to calculate pooled rates according to pre-specified treatment categories. The primary outcome was the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) during the study follow-up period. Results Seventeen articles, including 6,862 patients, were included in the meta-analysis. Fondaparinux had the lowest event rate with 1.4 events per 100 patient-years of follow-up (95% confidence interval [CI], 0.5–2.8, I 2 = 18%). Pooled event rates for DVT or PE ranged from 9.3 to 16.6 events per 100 patient-years across other treatment categories, and the pooled event rate for no treatment/placebo was 10.5 events per 100 patient-years (95% CI, 3.0–22.0). Major bleeding was low and similar across all treatment categories. Heterogeneity was moderate to high for most pooled estimates. Conclusion While pooled event rates suggest that fondaparinux achieves the lowest rate of DVT or PE, low-quality evidence for other treatments prevents firm conclusions about the optimal treatment for SVT.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

“…A recent systematic review and meta-analysis showed that fondaparinux achieved the lowest rate of DVT or PE (1.4 events per 100 patient years of follow up), and that for other treatments there was low quality evidence preventing firm conclusions about the optimal treatment for SVT. 272 In SURPRISE, an open label, non-inferiority phase IIIb RCT, 472 patients with symptomatic SVT were randomised to receive 10 mg oral rivaroxaban or 2.5 mg subcutaneous fondaparinux o.d. for 45 days.…”

Thrombosis and Haemostasis 2019 Editor's Choice Papers

“…Similarly, there are no clear guidelines to the nonetheless common clinical scenario of isolated superficial venous thrombosis. The systematic review and meta-analysis investigating therapeutic alternatives from Duffet et al 35 was thus very welcome, as reflected by the high Altmetrics Attention score it obtained. Also, very well received were the efforts from the Japan Environment & Children's Study Group who took advantage of a large Japanese cohort of more than 100,000 pregnancies to assess risks factors for VTE in pregnancy and post-partum.…”

Prognostic Significance of Concomitant Superficial Vein Thrombosis in Patients with Deep Vein Thrombosis of the Lower Limbs

“…established that anticoagulant therapy with Fondaparinux is more effective than placebo, Rivaroxaban is non-inferior to Fondaparinux, (4)(5)(6) and that SVT is closely linked to deep vein thrombosis (DVT) and pulmonary embolism (PE), thus highlighting the potential severity of the disease. (7-10) A number of observational studies published in the last years reveal that one in every four patients presenting with SVT in the lower limbs may also have DVT or PE concomitantly.…”