PEARLS 19, September 2007, written by Brian R McAvoy

Clinical question
What is the best treatment for superficial thrombophlebitis (ST) of the leg?

Bottom line
Both low molecular weight heparin (LMWH) and non-steroidal anti-inflammatory drugs (NSAIDs) reduce the incidence of the extension or the recurrence of ST by about 70 per cent compared to placebo (NNT* 6). Topical treatments relieve local symptoms but the trials do not report on progression to venous thromboembolism (VT). Surgical treatment and wearing elastic stockings are associated with a lower rate of VT and progression to thrombophlebitis compared with elastic stockings alone. (*NNT = number needed to treat to benefit one individual.)

Caveat
While the available data are too limited to make clear recommendations, an intermediate dose of LMWH for at least a month appears reasonable. Adverse effects of treatment were not discussed in the review.

Context
ST is a relatively common problem, and may be associated with VT. Predisposing factors for ST and VT are similar, and include varicose veins, immobilisation of the legs, the period after surgery, trauma, pregnancy and the period immediately following childbirth, active malignancies, use of the oral contraceptive or hormone replacement therapy and obesity.

Cochrane Systematic Review
Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database of Systematic Reviews 2007, Issue 2. Article No. CD004982. DOI: 10.1002/14651858.CD004982.pub3 Note: This review contains 24 trials with 2469 participants.