Superficial vein thrombosis – epidemiology, diagnostics, treatment

Czech version

Authors: J. Hirmerová
Authors‘ workplace: II. interní klinika LF UK a FN Plzeň
Published in: Kardiol Rev Int Med 2014, 16(4): 308-311
Category: Internal Medicine

Overview

Superficial vein thrombosis, previously more commonly known as superficial thrombophlebitis, in recent times is considered a form of venous thromboembolic disease. The risk factors largely overlap with the risk factors for deep vein thrombosis. Moreover, recent epidemiologic studies in patients with superficial vein thrombosis have revealed quite a high rate of concurrent or subsequent deep vein thrombosis or even pulmonary embolism. Ultrasound exam of both superficial and deep lower limb veins is recommended in the diagnostic process. Due to the disease heterogeneity and the lack of valid evidence, the guidelines for treatment are not unequivocal. Most authors are inclined to recommend anticoagulation – low‑ molecular‑ weight heparin or fondaparinux – but the intensity and duration of treatment are not clearly specified. So far, the approach to superficial vein thrombosis has been rather controversial and there is a need for further high‑quality studies to obtain valid data.

Keywords:
superficial vein thrombosis – deep vein thrombosis – risk factors – anticoagulation therapy

Sources

1. Kalodiki E, Stvrtinova V, Allegra C et al. Superficial vein thrombosis: a consensus statement. Int Angiol 2012; 31: 203– 316.

2. Frappé P, Buchmuller‑ Cordier A, Bertoletti L et al. Annual diagnosis rate of superficial vein thrombosis of the lower limbs: the STEPH community‑based study. J Thromb Haemost 2014; 12: 831– 838. doi: 10.1111/ jth.12575.

3. Legnani C, Cini M, Cosmi B et al. Inherited and acquired thrombophilic alterations in patients with superficial vein thrombosis of lower limbs. Thromb Haemost 2014; 111: 1194–1196. doi: 10.1160/ TH13‑ 11‑ 0925.

4. Bauersachs RM. Diagnosis and treatment of superficial vein thrombosis. Hamostaseologie 2013; 33: 232– 240. doi: 10.5482/ HAMO‑ 13‑ 04‑ 0027.

5. Blättler W, Schwarzenbach B, Largiadèr J. Superficial vein thrombophlebitis – serious concern or much ado about little? Vasa 2008; 37: 31– 38.

6. Karathanos C, Exarchou M, Tsezou A et al. Factors associated with the development of superficial vein thrombosis in patients with varicose veins. Thromb Res 2013; 132: 47– 50. doi: 10.1016/ j.thromres.2013.05.017.

7. Kakkos SK, Lampropoulos G, Papadoulas S et al. Seasonal variation in the incidence of superficial venous thrombophlebitis. Thromb Res 2010; 126: 98– 102. doi: 10.1016/ j.thromres.2010.04.016.

8. Decousus H, Quéré I, Presles E et al. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med 2010; 152: 218– 224. doi: 10.7326/ 0003‑ 4819‑ 152‑ 4‑ 201002160‑ 00006.

9. Galanaud JP, Genty C, Sevestre MA et al. Predictive factors for concurrent deep‑ vein thrombosis and symptomatic venous thromboembolic recurrence in case of superficial venous thrombosis. The OPTIMEV study. Thromb Haemost 2011; 105: 31– 39. doi: 10.1160/ TH10‑ 06‑ 0406.

10. Baggen VJ, Chung K, Koole K et al. Association of varicosities and concomitant deep venous thrombosis in patients with superficial venous thrombosis, a systematic review. Eur J Gen Pract 2014: 1– 7. doi: 10.3109/ 13814788.2014.919629.

11. Galanaud JP, Bosson JL, Genty C et al. Superficial vein thrombosis and recurrent venous thromboembolism: a pooled analysis of two observational studies. J Thromb Haemost 2012; 10: 1004– 1011. doi: 10.1111/ j.1538‑ 7836.2012.04704.x.

12. Cosmi B, Filippini M, Campana F et al. Risk factors for recurrent events in subjects with superficial vein thrombosis in the randomized clinical trial SteFlux (Superficial Thromboembolism Fluxum). Thromb Res 2014; 133: 196– 202. doi: 10.1016/ j.thromres.2013.12.005.

13. van Langevelde K, Lijfering WM, Rosendaal FR et al. Increased risk of venous thrombosis in persons with clinically diagnosed superficial vein thrombosis: results from the MEGA study. Blood 2011; 118: 4239– 4241. doi: 10.1182/ blood‑ 2011‑ 05‑ 356071.

14. Roach RE, Lijfering WM, van Hylckama Vlieg A et al. The risk of venous thrombosis in individuals with a history of superficial vein thrombosis and acquired venous thrombotic risk factors. Blood 2013; 122: 4264– 4269. doi: 10.1182/ blood‑ 2013‑ 07‑ 518159.

15. Vítovec M, Pechácek V. Czech Angiologic Society. Guidelines for duplex ultrasound exam of limb veins. Vnitr Lek 2009; 55: 136– 146.

16. Decousus H, Frappé P, Accassat S et al. Epidemiology, diagnosis, treatment and management of superficial‑ vein thrombosis of the legs. Best Pract Res Clin Haematol 2012; 25: 275– 284. doi: 10.1016/ j.beha.2012.07.005.

17. Quenet S, Laroche JP, Bertoletti L et al. Value of a planned compression ultrasonography after an isolated superficial vein thrombosis: results from a prospective multicentre study. Eur J Vasc Endovasc Surg 2012; 43: 233– 237. doi: 10.1016/ j.ejvs.2011.11.006.

18. Marković M, Maksimović Z, Maksimović I et al. The role of duplex ultrasonography in surgical treatment of acute progressive thrombophlebitis of great saphenous vein. Int Angiol 2011; 30: 434– 440.

19. Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013; 4: CD004982. doi: 10.1002/ 14651858.CD004982.pub5.

20. Decousus H, Prandoni P, Mismetti P et al. Fondaparinux for the treatment of superficial‑ vein thrombosis in the legs. N Engl J Med 2010; 363: 1222– 1232. doi: 10.1056/ NEJMoa0912072.

21. Cosmi B, Filippini M, Tonti D et al. A randomized double‑blind study of low‑ molecular‑ weight heparin (parnaparin) for superficial vein thrombosis: STEFLUX (Superficial ThromboEmbolism and Fluxum). J Thromb Haemost 2012; 10: 1026– 1035. doi: 10.1111/ j.1538‑ 7836.2012.04727.x.

22. Kearon C, Kahn SR, Agnelli G et al. Antithrombotic therapy for venous thromboembolic disease:American College of Chest Physicians Evidence‑ Based Clinical Practice Guidelines (8th Edition). Chest 2008; 133 (Suppl 6): 454S‑ 545S. doi: 10.1378/ chest.08‑ 0658.

23. Kearon C, Akl EA, Comerota AJ et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence‑ Based Clinical Practice Guidelines. Chest 2012; 141 (Suppl 2): 419S‑ 494S. doi: 10.1378/ chest.11‑ 2301.

24. Trust CDEaR, Forum EV, Forum NAT et al. Prevention and treatment of venous thromboembolism: international consensus statement (guidelines according to scientific evidence). Clin Appl Thromb Hemost 2013; 19: 116– 118. doi: 10.1177/ 1076029612474840.

25. Lane TR, Sritharan K, Herbert JR et al. The disparate management of superficial venous thrombosis in primary and secondary care. Phlebology 2014. doi: 10.1177/ 0268355514521184.