How I treat superficial venous thrombosis

Abstract

Thrombosis of superficial veins has long been regarded as a benign disorder. If patients with a clinical diagnosis of superficial venous thrombosis (SVT) are thoroughly evaluated, the degree and extent of thrombosis in patients with SVT are characteristically underestimated (∼ 75% of the time) and such patients have coexistence (∼ 25% of the time) of, and/or rapid progression (∼ 10% of the time) to, systemic venous thromboembolism (VTE). Pulmonary embolism (PE; ∼ 25% of the time) and death (∼ 1% of the time) occur. Contributory risk factors for SVT are the same for VTE. Treatment of patients' SVT with parenteral anticoagulants appears to be both efficacious and certainly safe. I regard most patients with a clinical diagnosis of SVT the same as those with VTEs. Systemic anticoagulant therapy of patients with a clinical diagnosis of SVT obviates extensive imaging and laboratory workup and may be cost effective while encompassing treatment of any unknown concomitant thromboses with only low risk for hemorrhage. This decision is especially clear in those patients with known hypercoagulability. Patients without clinical risk factors are at lower risk to develop VTE complications and might be those who can be simply observed.