Quality of evidence underlying the management of thrombophlebitis

Abstract

Objective: Superficial thrombophlebitis (ST) is commonly associated with varicose veins, although it may occur anywhere else in the body. The aim of this study was to review the quality of the evidence underlying the management of ST. Methods: Review of the literature on the management of ST over a 20-year period carried out using Medline and manual searching. The current management of ST was then divided into levels of evidence as defined by the US Agency for Health Care Policy and Research. Results: Superficial thrombophlebitis of varicose veins of the lower limb can be treated by saphenofemoral ligation with stripping of the proximal vein and surgical excision of the thrombosed segment (levels Ib and III). In the presence of deep vein thrombosis, oral anticoagulant (OC) is recommended (levels Ib and IIa). Hypercoagulable state should be investigated if ST occurs in the absence of varicose veins. In primary hypercoagulable state, disconnection of the saphenofemoral junction should be performed in patients at high risk of pulmonary embolism. Oral anticoagulant should be instituted after the first thrombotic event (level III). In secondary hypercoagulable state, OC with treatment of the underlying cause is recommended (level IV). Conclusions: The quality of evidence supporting the management of ST varies considerably. Further randomized studies are required to support some of the current management methods.