Superficial thrombophlebitis guidelines

 

Superficial venous thrombosis or thrombophlebitis (STP) in the lower limb is a relatively common, painful, and in many cases self-limiting condition. It can be sterile (majority of cases, associated with varicose veins), infective/traumatic (associated with trauma or cannulation, antibiotics may have a place) or migratory (rare, consider paraneoplastic cause).

Around 10-21% of patients with STP will already have DVT at presentation and a further 3-4% will progress to it if untreated. Patients with at least 5 cm of thrombus in a superficial vein are more likely to have underlying DVT if the STP is in the proximal long saphenous vein (within 10 cm of the saphenofemoral junction). Sterile STP within a varicose vein is less likely to be associated with underlying DVT. D-dimer is of no value, it may be elevated in both.

 

  • Patients with clinical signs of superficial thrombophlebitis affecting the proximal (above knee) long saphenous vein should have an ultrasound scan to exclude concurrent DVT.

  • Patients with STP within 3cm of the sapheno-femoral junction should be considered for therapeutic anticoagulation

  • Patients with superficial thrombophlebitis, without DVT, should have anti-embolism stockings and, if extending above the knee, be considered for treatment with prophylactic doses of LMWH for up to 30 days or fondaparinux for 45 days (JAMA 2018;320:2367). The absolute benefit of this strategy is small, with a NNT of 90. DOACs are not licensed for this indication but have been used.

  • If LMWH is contraindicated, or where the STP is confined to the calf, 8-12 days of oral NSAIDs should be offered. This reduces risk of extension and recurrence of STP but not DVT/PE risk.

  • There is insufficient evidence to support the use of topical heparinoids

 

Taken from the BCSH guidelines, page 7

Royal Cornwall Hospital

Truro

Cornwall TR1 3LJ

For Life-Threatening Emergencies Call 999

© 2023 by Acute GP Service, CPFT.