Sections

Treatment

Medical Care

The location of the thrombosis directs the treatment.

If progression to DVT is suspected or proven, adequate anticoagulation is imperative to prevent PE and other possible long-term complications of DVT.

Low molecular weight heparin (LMWH) or fondaparinux is considered the treatment of choice for SVT, although the appropriate length of treatment is unclear. Forty-five days of treatment is recommended by the American College of Chest Physicians.^[118]Topical treatment alone is not adequate.^[119]The use of LMWH in patients with SVT may decrease perivascular inflammation. LMWH limits neutrophil extravasation.^[120]Thus, LMWH has anti-inflammatory properties in addition to anticoagulant properties. High doses of unfractionated heparin are shown to be more effective in preventing thromboembolic combinations than prophylactic doses.^[121]

LMWH and nonsteroidal anti-inflammatory drugs (NSAIDs) both were shown to decrease the incidence of thrombophlebitis spread by approximately 70% in a meta-analysis of 24 studies and nearly 2500 patients.^[119]In a small study of 72 patients, LMWH (dalteparin) was found to be superior to NSAIDs (ibuprofen) in preventing extension of DVT.^[122]

Alternatively, superficial relapsing superficial venous thrombophlebitis may be treated with subcutaneously placed fondaparinux or oral rivaroxaban.^[123]A large review of 30 studies involving 6507 participants with SVT of the legs found a 6-week course of fondaparinux to be a valid therapeutic option.^[124]

Patients with extensive involvement of leg varices should receive anticoagulants. This treatment is particularly important if the proximal part of the SFJ is involved. In addition to propagation of the thrombus through the SFJ, 11-40% of patients with SVT at the SFJ have evidence of concurrent DVT.^{[110, 111, 125, 126]}In these patients, anticoagulation for 6 months resolved the DVT or SVT and prevented PE. This success occurred despite duplex ultrasonographic evidence of SVT progression to DVT in 2 of 20 patients.^[125]

The role of oral or topical NSAIDs and compression therapy is unclear, as data are insufficient to draw meaningful conclusions.^[106]Aspirin or other NSAIDs may be helpful in limiting both inflammation and pain. NSAIDs are associated with lower rates of SVT progression compared with placebo.^[106]Adequate graduated compression should be maintained, and the patient should ambulate frequently until the pain and inflammation resolve. In addition to adequate graduated compression, drainage of the thrombi after their liquefaction (approximately 2 wk after onset of the lesion) hastens the otherwise slow, painful resorption process.^[127]

Other treatment modalities have been tried but lack conclusive results from large clinical trials. Pycnogenol (an oral antithrombotic agent) has been found to decrease the number of thrombotic events during long-haul flights.^[128]Essaven gel improved the signs and symptoms of SVT of the arms.^[129]Diclofenac gel and Exhirud ointment are no longer used or are used very infrequently as topical treatments.^[119]

Surgical Care

Emergency surgical interventions may be effective in preventing complications of SVT.^[130]Surgical interventions are associated with the lowest incidence of extension of the thrombus and allow the patient to return to work faster than nonsurgical modalities.^[128]

Under the appropriate circumstances, incision and drainage of the clot should be attempted to alleviate pain.

If the thrombosis extends into the deep venous system, ligation and stripping of the affected vein should be considered.

Consultations

SVT can usually be treated conservatively, as described above, unless extension into the deep venous system is imminent.

Activity

Patients should be encouraged to be ambulatory.

Prevention

The routine use of graduated support stockings (class I or II), especially when the patient is confined on an airplane or otherwise, is extremely important.

Long-Term Monitoring

Follow up patients with SVT at weekly intervals until complete resolution occurs to ensure against its progression to DVT.

Routinely monitor patients with DVT, especially while they are receiving anticoagulant therapy.

Medication

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Media Gallery

Superficial thrombophlebitis. Courtesy of DermNet New Zealand (http://www.dermnetnz.org/assets/Uploads/vascular/thrombophlebitis.jpg).
Deep venous thrombosis.

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Author

Padma Chitnavis, MD Resident Physician, Department of Dermatology, Howard University Hospital and Veterans Affairs Medical Center

Disclosure: Nothing to disclose.

Coauthor(s)

Mary Piazza Maiberger, MD Assistant Professor of Dermatology, Howard University College of Medicine; Assistant Clinical Professor of Dermatology, George Washington University School of Medicine and Health Sciences; Chief of Dermatology and Residency Program Site Director, Washington DC VA Medical Center

Mary Piazza Maiberger, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, Washington DC Dermatological Society, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Michael J Wells, MD, FAAD Dermatologic/Mohs Surgeon, The Surgery Center at Plano Dermatology

Michael J Wells, MD, FAAD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Texas Medical Association

Disclosure: Nothing to disclose.

Julia R Nunley, MD Professor, Department of Dermatology, Virginia Commonwealth University Medical Center

Julia R Nunley, MD is a member of the following medical societies: American Academy of Dermatology, American College of Physicians, American Society of Nephrology, International Society of Nephrology, Medical Dermatology Society, Medical Society of Virginia, National Kidney Foundation, Phi Beta Kappa, Women's Dermatologic Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: American Board of Dermatology<br/>Author for: Up-to-date.

Chief Editor

Dirk M Elston, MD Professor and Chairman, Department of Dermatology and Dermatologic Surgery, Medical University of South Carolina College of Medicine

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

Zoltan Trizna, MD, PhD Private Practice

Zoltan Trizna, MD, PhD is a member of the following medical societies: Texas Medical Association

Disclosure: Nothing to disclose.

Mitchel P Goldman, MD Voluntary Clinical Professor of Dermatology, University of California, San Diego, Medical Center; Dermatologist, West Dermatology and Cosmetic Laser Dermatology

Mitchel P Goldman, MD is a member of the following medical societies: Aerospace Medical Association, American Academy of Cosmetic Surgery, American Academy of Dermatology, American College of Phlebology, American Medical Association, American Society for Dermatologic Surgery, American Society for Laser Medicine and Surgery, American Society of Lipo-Suction Surgery, California Medical Association, Dermatology Foundation, Phi Beta Kappa, San Diego County Medical Society

Disclosure: Nothing to disclose.

Carrie L Kovarik, MD Assistant Professor of Dermatology, Dermatopathology, and Infectious Diseases, University of Pennsylvania School of Medicine

Carrie L Kovarik, MD is a member of the following medical societies: Alpha Omega Alpha

Disclosure: Nothing to disclose.

Melanie D Palm, MD, MBA, FAAD Director, Art of Skin MD; Assistant Volunteer Clinical Professor, University of California, San Diego, School of Medicine; Affiliate Physician, Scripps Encinitas Memorial Hospital

Melanie D Palm, MD, MBA, FAAD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, Women's Dermatologic Society

Disclosure: Nothing to disclose.

Thrombophlebitis Treatment & Management

Medical Care

Surgical Care

Consultations

Activity

Prevention

Long-Term Monitoring

References

Tables

Contributor Information and Disclosures

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