Guidelines for superficial venous thrombosis

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Abstract

Superficial venous thrombosis (SVT) or superficial thrombophlebitis is characterized by thrombi within superficial veins, with partial involvement or occlusion of the lumen and inflammatory reaction along the course of the vein. Clinical diagnosis tends to be straightforward, but supplementary tests and examinations are needed to confirm thrombosis extension and possible thromboembolic complications. SVT can be associated with deep venous thrombosis in 6 to 40% of cases, with asymptomatic pulmonary embolism (PE) in 20 to 33%, and with symptomatic PE in 2 to 13%. Despite the morbidity and complications, there are currently no Brazilian guidelines for SVT. These guidelines cover the most important issues related to SVT definition, terminology, and etiology, and set out recommendations for diagnosis and treatment.

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Most cited references 75

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Clinical guidelines for testing for heritable thrombophilia.

Elaine Gray, Antonios M. Makris, Mike Greaves … (2010)

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Thrombophilia, clinical factors, and recurrent venous thrombotic events.

Frits Rosendaal, C Christiansen, Jan P. Vandenbroucke … (2005)

Data on the recurrence rate of venous thrombotic events and the effect of several risk factors, including thrombophilia, remain controversial. The potential benefit of screening for thrombophilia with respect to prophylactic strategies and duration of anticoagulant treatment is not yet known. To estimate the recurrence rate of thrombotic events in patients after a first thrombotic event and its determinants, including thrombophilic abnormalities. Prospective follow-up study of 474 consecutive patients aged 18 to 70 years without a known malignancy treated for a first objectively confirmed thrombotic event at anticoagulation clinics in the Netherlands. The Leiden Thrombophilia Study (LETS) was conducted from 1988 through 1992 and patients were followed up through 2000. Recurrent thrombotic event based on thrombophilic risk factors, sex, type of initial thrombotic event (idiopathic or provoked), oral contraceptive use, elevated levels of factors VIII, IX, XI, fibrinogen, homocysteine, and anticoagulant deficiencies. A total of 474 patients were followed up for mean (SD) of 7.3 (2.7) years and complete follow-up was achieved in 447 (94%). Recurrence of thrombotic events occurred in 90 patients during a total of 3477 patient-years. The rate of thrombotic event recurrence was 25.9 per 1000 patient-years (95% confidence interval [CI], 20.8-31.8 per 1000 patient-years). The incidence rate of recurrence was highest during the first 2 years (31.9 per 1000 patient-years; 95% CI, 20.3-43.5 per 1000 patient-years). The risk of thrombotic event recurrence was 2.7 times (95% CI, 1.8-4.2 times) higher in men than in women. Patients whose initial thrombotic event was idiopathic had a higher risk of a thrombotic event recurrence than patients whose initial event was provoked (hazard ratio [HR], 1.9; 95% CI, 1.2-2.9). Women who used oral contraceptives during follow-up had a higher thrombotic event recurrence rate (28.0 per 1000 patient-years; 95% CI, 15.9-49.4 per 1000 patient-years) than those who did not (12.9 per 1000 patient-years; 95% CI, 7.9-21.2 per 1000 patient-years). Recurrence risks of a thrombotic event by laboratory abnormality ranged from an HR of 0.6 (95% CI, 0.3-1.1) in patients with elevated levels of factor XI to an HR of 1.8 (95% CI, 0.9-3.7) for patients with anticoagulant deficiencies. Prothrombotic abnormalities do not appear to play an important role in the risk of a recurrent thrombotic event. Testing for prothrombotic defects has little consequence with respect to prophylactic strategies. Clinical factors are probably more important than laboratory abnormalities in determining the duration of anticoagulation therapy.

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Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study.

Bernhard Becker, Patrick Mismetti, Emilie Presles … (2010)

Superficial venous thrombosis (SVT) is perceived to have a benign prognosis. To assess the prevalence of venous thromboembolism in patients with SVT and to determine the 3-month incidence of thromboembolic complications. National cross-sectional and prospective epidemiologic cohort study. (ClinicalTrials.gov registration number: NCT00818688) French office- and hospital-based vascular medicine specialists. 844 consecutive patients with symptomatic SVT of the lower limbs that was at least 5 cm on compression ultrasonography. Incidence of venous thromboembolism and extension or recurrence of SVT in patients with isolated SVT at presentation. Among 844 patients with SVT at inclusion (median age, 65 years; 547 women), 210 (24.9%) also had deep venous thrombosis (DVT) or symptomatic pulmonary embolism. Among 600 patients without DVT or pulmonary embolism at inclusion who were eligible for 3-month follow-up, 58 (10.2%) developed thromboembolic complications at 3 months (pulmonary embolism, 3 [0.5%]; DVT, 15 [2.8%]; extension of SVT, 18 [3.3%]; and recurrence of SVT, 10 [1.9%]), despite 540 patients (90.5%) having received anticoagulants. Risk factors for complications at 3 months were male sex, history of DVT or pulmonary embolism, previous cancer, and absence of varicose veins. The findings are from a specialist referral setting, and the study was terminated before the target patient population was reached because of slow recruitment. A substantial number of patients with SVT exhibit venous thromboembolism at presentation, and some that do not can develop this complication in the subsequent 3 months. GlaxoSmithKline, sanofi-aventis, and the Ministère Francais de la Santé et des Sports (Programme Hospitalier de Recherche Clinique).

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Author and article information

Journal

Journal ID (nlm-ta): J Vasc Bras

Journal ID (iso-abbrev): J Vasc Bras

Journal ID (publisher-id): jvb

Title: Jornal Vascular Brasileiro

Publisher: Sociedade Brasileira de Angiologia e de Cirurgia Vascular (SBACV)

ISSN (Print): 1677-5449

ISSN (Electronic): 1677-7301

Publication date (Electronic, pub): 20 November 2019

Publication date (Electronic, collection): 2019

Volume: 18

Electronic Location Identifier: e20180105

Affiliations

[1 ] originalFaculdade de Medicina de Marília – FAMEMA, Marília, SP, Brasil.

[2 ] originalUniversidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil.

[3 ] originalFaculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.

[4 ] originalUniversidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.

[5 ] originalUniversidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

[1 ] originalFaculdade de Medicina de Marília – FAMEMA, Marília, SP, Brasil.

[2 ] originalUniversidade Estadual de Campinas – UNICAMP, Campinas, SP, Brasil.

[3 ] originalFaculdade de Medicina de São José do Rio Preto – FAMERP, São José do Rio Preto, SP, Brasil.

[4 ] originalUniversidade de São Paulo – USP, Faculdade de Medicina de Ribeirão Preto – FMRP, Ribeirão Preto, SP, Brasil.

[5 ] originalUniversidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Botucatu, SP, Brasil.

Author notes

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

CorrespondenceMarcelo José de Almeida Rua 7 de Setembro, 734 CEP 17502-020 - Marília (SP), Brasil Tel.: +55 (14) 34135-475 E-mail: mjalmeida13@ 123456gmail.com

Author informationMJA - Faculdade de Medicina de Marília (FAMEMA); MSc and PhD in Surgery, UNESP Botucatu; Board-certified in Endovascular Surgery by SoBRICE; Full member, SBACV. ATG - Faculdade de Medicina, UNICAMP; Tenured Professor, UNICAMP; Chief, Serviço de Cirurgia Vascular e Endovascular, UNICAMP; Full member, SBACV. DM - Faculdade de Medicina de São José do Rio Preto (FAMERP); Professor, Vascular and Endovascular Surgery, FAMERP. EEJ - Faculdade de Medicina de Ribeirão Preto (USP); PhD, Professor, Faculdade de Medicina, Universidade de São Paulo (USP). LH - Faculdade de Medicina de Marília (FAMEMA); MSc, PhD in Surgery, UNESP Botucatu. MLS and RM - Faculdade de Medicina de Botucatu (UNESP); PhD, Professor, Vascular and Endovascular Surgery, Faculdade de Medicina de Botucatu. MAG - Faculdade de Medicina (UNICAMP); MSc in Surgery, UNICAMP; Assistant physician, Vascular and Endovascular Surgery, UNICAMP. SR - Faculdade de Medicina de São José do Rio Preto (FAMERP); PhD, Assistant Professora; Professor, Vascular and Endovascular Surgery, FAMERP. WBY - Faculdade de Medicina de Botucatu (UNESP); Tenured Professor, Vascular and Endovascular Surgery, Faculdade de Medicina de Botucatu; Full member, SBACV; Editor-in-Chief, Jornal Vascular Brasileiro (JVB).

Author contributionsConception and design: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Analysis and interpretation: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Data collection: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Writing the article: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Critical revision of the article: WBY, MJA Final approval of the article*: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Statistical analysis: N/A. Overall responsibility: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. *All authors have read and approved of the final version of the article submitted to J Vasc Bras.

Conflito de interesse: Os autores declararam não haver conflitos de interesse que precisam ser informados.

Correspondência Marcelo José de Almeida Rua 7 de Setembro, 734 CEP 17502-020 - Marília (SP), Brasil Tel.: (14) 34135-475 E-mail: mjalmeida13@ 123456gmail.com

Informações sobre os autores MJA - Faculdade de Medicina de Marília (FAMEMA); Mestre e doutor em cirurgia, UNESP Botucatu; Especialista em Cirurgia Endovascular, SoBRICE; Membro titular SBACV. ATG - Faculdade de Medicina, UNICAMP; Livre Docente, UNICAMP; Chefe, Serviço de Cirurgia Vascular e Endovascular, UNICAMP; Membro titular SBACV. DM - Faculdade de Medicina de São José do Rio Preto (FAMERP); Docente, Cirurgia Vascular e endovascular, FAMERP. EEJ - Faculdade de Medicina de Ribeirão Preto (USP); Professor doutor, Faculdade de Medicina, Universidade de São Paulo (USP). LH - Faculdade de Medicina de Marília (FAMEMA); Mestre, doutor em cirurgia, UNESP Botucatu. MLS e RM - Faculdade de Medicina de Botucatu (UNESP); Professores doutores, Disciplina de Cirurgia Vascular e Endovascular, Faculdade de Medicina de Botucatu. MAG - Faculdade de Medicina (UNICAMP); Mestre em cirurgia, UNICAMP; Médico assistente, Cirurgia Vascular e Endovascular, UNICAMP. SR - Faculdade de Medicina de São José do Rio Preto (FAMERP); Professora assistente doutora; Docente, Cirurgia Vascular e Endovascular, FAMERP. WBY - Faculdade de Medicina de Botucatu (UNESP); Livre docente, Disciplina de Cirurgia Vascular e Endovascular, Faculdade de Medicina de Botucatu; Membro titular SBACV; Editor chefe, Jornal Vascular Brasileiro (JVB).

Contribuições dos autores Concepção e desenho do estudo: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Análise e interpretação dos dados: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Coleta de dados: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Redação do artigo: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Revisão crítica do texto: WBY, MJA Aprovação final do artigo*: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. Análise estatística: N/A. Responsabilidade geral pelo estudo: WBY, ATG, MJA, DM, EEJ, MLS, LH, MAG, RM, SR. *Todos os autores leram e aprovaram a versão final submetida do J Vasc Bras.

Author information

Marcelo José de Almeida http://orcid.org/0000-0002-9143-604X/

Ana Terezinha Guillaumon http://orcid.org/0000-0002-5487-4892/

Marcone Lima Sobreira http://orcid.org/0000-0003-2271-5878/

Article

Publisher ID: jvbDR20180105_PT Other ID: 02001

DOI: 10.1590/1677-5449.180105

PMC ID: 6880617

SO-VID: c07e3500-8606-46b0-8550-fb67ed66d29e

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 16 January 2019

Date accepted : 05 August 2019

Page count

Figures: 4, Tables: 2, Equations: 0, References: 72

Guidelines for superficial venous thrombosis

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Most cited references 75

Clinical guidelines for testing for heritable thrombophilia.

Thrombophilia, clinical factors, and recurrent venous thrombotic events.

Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study.

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