Treatment for superficial thrombophlebitis of the leg

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. Objectives: To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of the legs. Search strategy: The Cochrane Peripheral Vascular Diseases Group searched their specialized register (last searched 16 February 2007), and the Cochrane Central Register of Controlled Trials (CENTRAL) (last searched Issue 1, 2007. We searched MEDLINE (1966 to January 2006), EMBASE (1980 to January 2006), and hand searched reference lists of relevant papers and conference proceedings. Selection criteria: Randomized trials evaluating topical, medical, and surgical treatments for ST of the leg including 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 extracted independently from the included studies and any disagreements resolved by consensus. Main results: Twenty-four studies involving 2469 participants with ST of the legs were included in this review. The methodological quality of most of the trials was poor. Treatment ranged from low molecular weight heparin (LMWH), to non-steroidal anti-inflammatory agents (NSAIDs), topical treatment, surgery, oral, intramuscular, and intravenous treatments. Both LMWH and NSAIDs significantly reduced the incidence of ST extension or recurrences by about 70% compared with placebo and both seemed to have a similar efficacy and safety. 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: Low molecular weight heparin and NSAIDs appear as the current best therapeutic options for ST of the legs. While the available data are too limited to make clear recommendations, an intermediate dose of LMWH for at least amonth might be advised. Further research is needed to assess the role of NSAIDs and LMWH, 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. Copyright © 2008 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.