Superficial Vein Thrombosis Research Articles

Risk of venous thromboembolism after discontinuing prophylactic or therapeutic anticoagulation in patients with haematologic malignancies because of thrombocytopenia.

Although the rates of thrombocytopenia in patients with hematologic malignancies are well known, clinical reports of patients with haematological malignancies presenting with thrombocytopenia who developed venous thromboembolism (VTE) are rare. Defining the risk of VTE in patients with hematologic malignancies in whom anticoagulation is discontinued could help to individualize concepts of anticoagulation. We performed a retrospective analysis of medical records of patients with hematologic malignancies and thrombocytopenia grade 3 (25 × 109/L to < 50 × 109/L) or more severe in 2019-2022 in the Department of Haemato-Oncology at HELIOS Klinikum Krefeld. Data from 67 patients (34 (51%) males, 33 (49%) females) aged between 22 and 82years (38 leukaemia, 23 lymphoma, 6 other) were included. Prophylactic anticoagulation was performed in 59 (88%) patients and therapeutic due to atrial fibrillation in 8 (12%). Anticoagulation was discontinued in 37 (55%) patients due to thrombocytopenia. Thrombotic events occurred in eight (12%) and minor bleeding in two (3%) patients. Seven patients developed a deep vein thrombosis (DVT) or superficial vein thrombosis (SVT) of the upper limbs, only one patient had a thrombosis of the femoral veins. Thrombotic event were much more frequent in patients suffering from leukaemia compared to lymphoma. Two thrombotic events occurred despite continued prophylaxis (2 of 30, 6.6%), the other six after discontinuing of anticoagulation (6 of 37, 16.2%). Both bleedings occurred in the group with continued anticoagulation. Five of the six patients with a thrombotic event, but without anticoagulation, received anticoagulation again despite a low platelet count and no bleeding was observed. Only one patient with jugular vein thrombosis and a platelet count around 4 × 109/L remained without anticoagulation and no thrombus formation was observed. Risk of VTE in our patients with haematologic malignancies in whom anticoagulation is discontinued due to thrombocytopenia grade 3 is about 2.5 times higher than in patients in whom anticoagulation is continued and predominantly affects patients with leukaemia and upper extremity.

Current Diagnostic and Therapeutic Challenges in Superficial Venous Thrombosis.

Superficial venous thrombosis (SVT) is a fairly common disorder, characterized by the formation of thrombi inside superficial veins, with or without an associated inflammatory reaction. Its evolution is frequently self-limited. However, serious complications may change this clinical course with extension to deep vein thrombosis (DVT) and pulmonary embolism (PE). SVT shares similar risk factors with DVT and is frequently associated with the presence of varicose veins. However, the occurrence of non-varicose veins could conceal risk factors such as malignancies, thrombophilia, or Buerger's disease. While the clinical diagnosis is generally straightforward, additional diagnostic evaluations are often necessary. Duplex ultrasound (DUS) is an invaluable tool that provides the location of SVT, the proximity to the sapheno-femoral junction, and the clot length, all of which influence the decision for optimal management. The treatment of SVT should be symptomatic, pathogenic (limiting the extension of thrombosis), and prognostic (to prevent complications). There are several guidelines that provide recommendations, and despite the need for more consensus and for further studies, the treatment of SVT should be mainly medical, including anticoagulation in specific clinical situations and symptom relief, with invasive treatment in a minority of cases. Initiation, intensity, and length of anticoagulant treatment should be based on the eventual risk of progression to DVT or PE, which can be high, intermediate, or low, based on the location of SVT and the clot length. Our review summarizes the evaluation and proper management of SVT and highlights the importance of a shared decision within the heart team regarding this condition in order to prevent further complications.

Treatment of Superficial Vein Thrombosis: Recent Advances, Unmet Needs and Future Directions.

Once considered relatively benign, superficial vein thrombosis (SVT) of the lower limbs is linked to deep vein thrombosis (DVT) or pulmonary embolism (PE) in up to one fourth of cases. Treatment goals include alleviating local symptoms and preventing SVT from recurring or extending into DVT or PE. Fondaparinux 2.5 mg once daily for 45 days is the treatment of choice for most patients with SVT. Potential alternatives include intermediate-dose low-molecular-weight heparin or the direct oral factor Xa inhibitor rivaroxaban, however, these require further evidence. Despite these treatment options, significant gaps remain, including the role of systemic or topical anti-inflammatory agents alone or combined with anticoagulants, and the optimal duration of anticoagulation for patients at varying risk levels. Additionally, the efficacy and safety of factor Xa inhibitors other than rivaroxaban, management of upper extremity SVT, and optimal treatment for SVT near the sapheno-femoral or sapheno-popliteal junctions are not well understood. This narrative review aims to summarize current evidence on anticoagulant treatment for SVT, highlight key unmet needs in current approaches, and discuss how ongoing studies may address these gaps.

Comparative analysis of 'functional excision' of heterotopic ossification around the hip - computed tomography (CT) navigation guided versus conventional excision.

We aim to analyse and compare the efficacy of the excision of HO around the hip with and without CT-guided navigation. We also aim to compare the functional outcome between CT navigation guided versus conventional excision of HO. This study is a retrospective analysis of prospectively collected data from 2015 to 2022. There were 23 patients (24 hips) in the final cohort. Intraoperative CT navigation guided excision was performed in 7 hips and conventional excision of HO was done in 17 hips. The HO was classified by Brooker's grading in radiographs. CT scan was taken preoperatively in all patients to exactly identify the volume, location and preoperative planning. The functional outcome was analysed according to Harris Hip Score (HHS) and International Hip Outcome Tool (iHOT) for self-ambulatory patients and improvement in the sitting or nursing care was assessed in patients mobilising with wheelchair or walker support. Any complications or recurrence noted postoperatively and in follow-up were recorded. The mean follow-up was 41.2 months in the CT navigation-guided excision group and 55 months in the conventional excision group. According to Brooker's grading, grade IV was present in 20 hips and grade III in four hips. Twelve patients were self-ambulatory and the other 12 patients were requiring support for mobilisation. There was a significant improvement in the HHS from 21.3 ± 3.7, 18.3 ± 2.5 preoperatively to 75.2 ± 8.3, 72.2 ± 4.3 postoperatively in the CT navigation guided and conventional group respectively (p < 0.001) in the self-ambulatory group. There was one anterior wall and one partial posterior wall fracture in the conventional group. One patient in the conventional group had a deep infection and recurrence. One patient had a superficial infection and another had superficial vein thrombosis in the CT guided excision group. Intraoperative CT navigation helps to exactly localize the HO and facilitates safe excision. Functional excision of the HO leads to better nursing care and functional outcomes between both groups.

Diagnosis and treatment of venous thrombosis

The subject of this guideline from the Institute of Family Medicine at the University of Zurich (IHAMZ) is the management of venous thrombosis. The review summarizes the current evidence and recommendations from international guidelines (1-6). The IHAMZ-guidelines focus on primary care, they also provide guidance on the coordination of general and specialist medical care as well as on the transition between outpatient and hospital care taking into account the special features of the Swiss healthcare system. The guideline is devided in two parts. Part 1 discusses the diagnosis and treatment of deep vein thrombosis (DVT). A validated algorithm is recommended for the diagnostic process, which begins with the assessment of the clinical probability. With the inclusion of the D-dimer test, the need for subsequent imaging diagnostics can be reduced. The differences between the evaluation of an initial and recurrent DVT are shown and the indications and scope of evidence-based environmental diagnostics (thrombophilia and tumor search) are presented. All patients with DVT should receive anticoagulation (AC) for 3-6 months, as there is a high risk of recurrence with AC 3 months. The duration of the subsequent secondary prophylaxis depends on the presumed risk of recurrence on the one hand and the risk of bleeding on the other. Part 2 is dedicated to special thrombosis situations such as shoulder-arm vein thrombosis (SAVT), cancer-associated thrombosis (CAT) and superficial vein thrombosis (SVT). The article on hormone- and pregnancy-associated DVT, developed together with the Department of Gynecology at the University Hospital of Zurich, discusses the importance of hormonal contraception and menopausal hormone replacement therapy (HRT) as a thrombogenic risk factor as well as special features in the diagnosis and treatment of thrombosis in pregnancy.

Risk of recurrence after discontinuing anticoagulation in patients with COVID-19- associated venous thromboembolism: a prospective multicentre cohort study

The clinical relevance of recurrent venous thromboembolism (VTE) after discontinuing anticoagulation in patients with COVID-19-associated VTE remains uncertain. We estimated the incidence rates and mortality of VTE recurrences developing after discontinuing anticoagulation in patients with COVID-19-associated VTE. A prospective, multicenter, non-interventional study was conducted between March 25, 2020, and July 26, 2023, including patients who had discontinued anticoagulation after at least 3 months of therapy. All patients from the registry were analyzed during the study period to verify inclusion criteria. Patients with superficial vein thrombosis, those who did not receive at least 3 months of anticoagulant therapy, and those who were followed for less than 15 days after discontinuing anticoagulation were excluded. Outcomes were: 1) Incidence rates of symptomatic VTE recurrences, and 2) fatal PE. The rate of VTE recurrences was defined as the number of patients with recurrent VTE divided by the patient-years at risk of recurrent VTE during the period when anticoagulation was discontinued. Among 1106 patients with COVID-19-associated VTE (age 62.3 ± 14.4 years; 62.9% male) followed-up for 12.5 months (p25-75, 6.3-20.1) after discontinuing anticoagulation, there were 38 VTE recurrences (3.5%, 95% confidence interval [CI]: 2.5-4.7%), with a rate of 3.1 per 100 patient-years (95% CI: 2.2-4.2). No patient died of recurrent PE (0%, 95% CI: 0-7.6%). Subgroup analyses showed that patients with diagnosis in 2021-2022 (vs. 2020) (Hazard ratio [HR] 2.86; 95% CI 1.45-5.68) or those with isolated deep vein thrombosis (vs. pulmonary embolism) (HR 2.31; 95% CI 1.19-4.49) had significantly higher rates of VTE recurrences. In patients with COVID-19-associated VTE who discontinued anticoagulation after at least 3 months of treatment, the incidence rate of recurrent VTE and the case-fatality rate was low. Therefore, it conceivable that long-term anticoagulation may not be required for many patients with COVID-19-associated VTE, although further research is needed to confirm these findings. Sanofi and Rovi, Sanofi Spain.

Is it safe to discontinue anticoagulant after surgical treatment of varicose vein disease, which caused pulmonary embolism?

Superficial vein thrombosis, which is mostly caused by lower extremity varicose vein disease, can be complicated by pulmonary embolism. At the same time, the optimal duration of anticoagulant therapy for pulmonary embolism originated from varicose vein thrombosis is still under debate. On the one hand, the presence of varicose veins is considered a small risk factor for the development of venous thromboembolic events, which persistence determines an increased risk of relapse and requires prolonged anticoagulant therapy. On the other hand, elimination of varicose veins is associated with reduced risk of subsequent venous thromboembolic events. The article describes a clinical case of recurrent pulmonary embolism after surgical treatment of varicose vein disease, which caused primary pulmonary embolism. A 45-year-old patient suffering from left lower extremity varicose vein disease for 5 years was admitted to the intensive care unit with suspected pulmonary embolism. The further examination revealed signs of thrombotic occlusion of the segmental and subsegmental branches of the pulmonary arteries bilaterally and the middle lobe branch of the right pulmonary artery, as well as signs of the right-sided heart overload. In this case, pulmonary embolism was found to originate from thrombosis of the trunk of the great saphenous vein ofthe left lower extremity with a proximal border at the level of the lower leg. No signs of deep vein involvement were detected. The parenteral anticoagulant therapy initiated in the hospital was followed by switching to therapeutic doses of rivaroxaban. The signs of recanalization of involved veins were identified after 6 months of treatment, and it was decided to perform endovenous laser coagulation of the trunk of the great saphenous vein combined with mini-phlebectomy of varicose tributaries on continuous oral anticoagulant therapy. The rivaroxaban therapy was completed a month after intervention. However, 7 days later the patient was diagnosed with repeated symptomatic pulmonary embolism, which originated from thrombosis of the left popliteal vein. It was recommended to resume anticoagulant therapy of indefinite duration. The article discusses the issues of optimal duration of treatment for pulmonary embolism originated from thrombosis of superficial varicose veins, as well as the possible timing of completion of anticoagulant therapy after the intervention.

Is Reducing Treatment Time for Lower Limb Superficial Venous Thrombosis Safe?

Is Reducing Treatment Time for Lower Limb Superficial Venous Thrombosis Safe?

Predictive factors of clot propagation in patients with superficial venous thrombosis towards deep venous thrombosis and pulmonary embolism: a systematic review and meta-analysis

ObjectiveA subset of patients with superficial venous thrombosis (SVT) experiences clot propagation towards deep venous thrombosis (DVT) and/or pulmonary embolism (PE). The aim of this systematic review is to identify...

Management of lower-extremity venous thromboembolism: An updated review.

According to the 2021 updated guidelines of the American College of Chest Physicians, the location of venous thromboembolism, the severity of symptoms, the risk of thrombus extension vs that of bleeding, and comorbidities all affect the decision to treat, the choice of anti-thrombotic agent, and the duration of therapy. In patients with isolated distal deep vein thrombosis without high-risk features, monitoring progression is recommended over initiating anticoagulation. However, treatment of proximal deep vein thrombosis with anticoagulation is strongly recommended by the guidelines. More evidence now supports the treatment of superficial vein thrombosis with anticoagulation in high-risk patients.

Two cases of venous thromboembolism in siblings after splenectomy due to a novel PROC gene mutation

BackgroundVenous thromboembolism(VTE)is a common multifactorial disease. Anticoagulant protein deficiency is the most usual hereditary thrombophilia in the Chinese people, which includes protein C(PC), protein S and antithrombin deficiencies.Case presentationA retrospective analysis was conducted on clinical manifestations, laboratory tests, genetic information, and other relevant data of siblings diagnosed with VTE in 2020 at the Department of Pediatrics of Shenzhen Second People’s Hospital. The proband, a 12-year-old female, was admitted to the hospital in December 2020 with a complaint of pain in the left lower limb for four days. The examination found that the PC activity was 53%, and B-ultrasound showed bilateral thrombosis of the great saphenous vein in the thigh segment. The proband’s younger brother, a 10-year-old male, was admitted to the hospital in January 2021 due to right lower limb pain for two weeks. PC activity is 40%. B-ultrasound showed superficial venous thrombosis in the left lower limb and upper limb. Both siblings suffered from thalassemia and underwent splenectomy before recurrent thrombosis occurred. The proband’s mother was asymptomatic, and her PC activity was 45%. Both cases were treated with warfarin anticoagulation, and their symptoms improved. The proband’s mother was found to have a heterozygous mutation at this locus through Sanger sequencing.ConclusionProtein C deficiency should be considered for venous thromboembolism in childhood. The heterozygous mutation 1204 A > G in PROC exon 9 in this family is reported for the first time.

Incidence and clinical progression of asymptomatic peripherally inserted central catheter–related thrombosis in solid neoplasm patients: ultrasound insights from a prospective cohort study

BackgroundManaging central venous catheters in patients with neoplasms is challenging, and peripherally inserted central catheter PORT (PICC-PORT) has emerged as a promising option for safety and efficacy. However, understanding the clinical progression of catheter-related thrombosis (CRT) in cancer patients with central venous catheters remains limited, especially in certain neoplasm types associated with a higher risk of venous thrombosis. ObjectivesThis study aims to assess the effectiveness of ultrasound-guided management in detecting and treating asymptomatic CRT in cancer patients with PICC. MethodsIn this prospective cohort study of 120 patients with solid neoplasms receiving chemotherapy, we investigated the incidence of isolated upper-extremity superficial vein thrombosis, upper-extremity deep vein thrombosis, and fibrin sheath formation through ultrasound follow-up at 30 and 90 days after catheter insertion. We analyzed risk factors associated with CRT and compared incidence rates between PICC-PORT and traditional PICC. ResultsAmong the cohort, 69 patients (57.5%) had high-risk thromboembolic neoplasm, and 31 cases (25.8%) of CRT were observed, mostly within 30 days, with only 7 cases (22.6%) showing symptoms. Traditional PICC use (odds ratio, 5.86; 95% CI, 1.14-30) and high-risk thromboembolic neoplasm (odds ratio, 4.46; 95% CI, 1.26-15.81) were identified as independent risk factors for CRT. ConclusionThe majority of CRT present asymptomatically within the first 30 days of venous catheter insertion in patients with solid neoplasms. Ultrasound follow-up is valuable for detecting asymptomatic CRT. The risk of CRT was lower with PICC-PORT than with PICC. Additionally, the risk of CRT was found to be higher in patients with high-risk thromboembolic neoplasms. It is crucial for larger studies to confirm the utility of treating asymptomatic thromboses and isolated superficial thrombosis.

Superficial Venous Thrombosis: A Comprehensive Review.

Superficial venous thrombosis (SVT), an inflammatory-thrombotic process of a superficial vein, is a relatively common event that may have several different underlying causes. This phenomenon has been generally considered benign, and its prevalence has been historically underestimated; the estimated incidence ranges from about 0.3 to 1.5 event per 1000 person-years, while the prevalence is approximately 3 to 11%, with different reports depending on the population studied. However, such pathology is not free of complications; indeed, it could extend to the deep circulation and embolize to pulmonary circulation. For this reason, an ultrasound examination is recommended to evaluate the extension of SVT and to exclude the involvement of deep circulation. Also, SVT may be costly, especially in the case of recurrence. Therefore, accurate management is necessary to prevent sequelae and costs related to the disease. This review aims to analyse the epidemiology of SVT, its complications, optimal medical treatment, and open questions with future perspectives.

Unrecognized Superficial Venous Thrombosis in a Female Division-1 Athlete: A Case Report

BACKGROUND: Superficial venous thrombosis (SVT) is a blood clot that forms in superficial veins and may occur after surgery. Treatment typically consists of anticoagulation medication and palliative care. CASE PRESENTATION: A 20-year-old female basketball athlete presented to physical therapy (PT) after posterior labral repair. Examination revealed tenderness along the medial forearm, venous distension of the hand, and discomfort with wrist extension overpressure and resisted wrist flexion. The patient was referred by the physical therapist to the team physician, who ordered ultrasonography, which demonstrated SVT of the right basilic vein. The patient was placed on anticoagulation medication for 4 months. OUTCOME AND FOLLOW-UP: At 4 months after initial diagnosis, a computed tomography venogram revealed resolution of SVT. The patient continued with physical therapy throughout this period, with no adverse effects reported. DISCUSSION: Physical therapists play an important role in medical screening and referral of patients who present with potential vascular complications postsurgery. Physical therapists may also safely implement a plan of care in patients who develop medical complications after surgery. JOSPT Cases 2024;4(1):34-38. Epub 26 January 2024. doi:10.2519/josptcases.2024.12174

Factors Associated with the Evolution of Superficial Vein Thrombosis and Its Impact on the Quality of Life: Results from a Prospective, Unicentric Study

Background: Superficial venous thrombosis (SVT) is a common clinical condition caused by inflammation and the presence of a thrombus inside a superficial vein. It has traditionally been considered a benign and banal disorder, although it can progress or can be associated with thromboembolic disease of deep territories in up to 20%, asymptomatic or symptomatic pulmonary embolism (PE), especially if it affects the main trunk of the internal saphenous vein. The impact of deep vein thrombosis on the quality of life and its sequelae have long been described in the literature; however, they have not been studied in superficial vein thrombosis. Objectives: We aimed to evaluate the risk factors, management, and complications of SVT and its impact on the quality of life of our patients. Methods: Observational, prospective, single-center study to evaluate the management of SVT. The ultrasound (US) was performed initially on symptomatic patients, during treatment with low-molecular-weight heparin (LMWH), at a follow-up, and at the end of 45 days of treatment. A quality-of-life questionnaire was administered to determine the risk factors, management, and complications of SVT at the moment of diagnosis and at the end of treatment. We included patients referred from the emergency department to a monographic consultation for thromboembolic disease, over 18 years of age with a diagnosis of acute SVT symptomatic, without contraindication to initiate anticoagulation. Results: In total, 63 patients were evaluated between October 2020 and April 2022. The mean age was 65.8 years (SD 13.5), of which 35 were women (55.6%), 39 presented cardiovascular risk factors (61.9%), 25 had a history of previous personal venous thromboembolism (VTE) (39.7%), and 10 had obesity (15.9%), 47 had chronic venous insufficiency or varicose veins (74.9%). During follow-up with ultrasound, 39.7% had partial revascularization, and at discharge, 63.5% had permeabilized the thrombosis against 19% who had residual thrombosis or progression of thrombosis. There was a positive correlation between mobility parameters and improvement in the performance of daily activities (rho = 0.35; p = 0.012) and with improvement in pain/discomfort (rho = 0.37; p = 0.007). An improvement in pain parameters was statistically significantly related to a global assessment health perception (rho = 0.48; p &lt; 0.001). Anxiety and depression parameters were related to a global assessment health perception (rho = 0.462; p = 0.001) and to an overall improvement at 12 months (rho = 0.45; p = 0.001). CONCLUSIONS: Superficial venous thrombosis (SVT) is a highly prevalent disease, which is traditionally considered banal and has good evolution, with heterogeneous management in clinical practice and limited information on patient selection for therapies, current treatment routes, and drug use, as well as outcomes. In recent years, the importance of this entity has become evident due to its frequency in clinical practice, its risk of complications, and the impact it has on the quality of life. This study’s results emphasize the importance of the diagnosis, treatment, and follow-up of superficial venous thrombosis.

Factors associated with the initial intracranial hemorrhage occurrence in patients with cerebral venous thrombosis

ObjectivesStudies focusing on intracranial hemorrhage (ICH) in patients with cerebral venous thrombosis (CVT) are limited; thus, we aimed to identify factors associated with the occurrence of ICH in Thai patients with CVT. MethodsThis retrospective cohort study recruited patients with CVT admitted to a tertiary university-based hospital between 2002 and 2022. The baseline characteristics, clinical presentations, radiographic findings, and etiologies were compared between the ICH and non-ICH groups. The factors with p < 0.2 in the univariate analysis were further analyzed using multivariable logistic regression analysis to identify independent factors associated with ICH in patients with CVT. ResultsOf 228 screenings, 202 patients were eligible. The incidence rate of ICH was 36.63%. The ICH group showed a higher prevalence of focal neurological deficits (63.51% vs. 26.56%, p < 0.001), seizures (68.92% vs. 21.88%, p < 0.001), dependency status at admission (60.81% vs. 39.84%, p = 0.004), superior sagittal sinus thrombosis (71.62% vs. 39.07%, p < 0.001), superficial cortical vein thrombosis (36.49% vs. 10.16%, p < 0.001), and hormonal use (17.57% vs. 7.03%, p = 0.021) than the non-ICH group. In contrast, the ICH group showed a lower prevalence of isolated increased intracranial pressure (10.81% vs. 21.88%, p = 0.048) than the non-ICH group. Seizures (adjusted odds ratio [aOR], 4.537; 95% confidence interval [CI], 2.085–9.874; p < 0.001), focal neurological deficits (aOR, 2.431; 95% CI, 1.057–5.593; p = 0.037), and superior sagittal sinus thrombosis (aOR, 1.922; 95% CI, 1.913–4.045; p = 0.045) were independently associated with ICH in the multivariable logistic regression analysis. ConclusionsSeizures, focal neurological deficits, and superior sagittal sinus thrombosis are associated with ICH in patients with CVT.

Incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies: A single-center, prospective cohort study.

Incidence of venous thromboembolism (VTE) is higher than the expected in patients with hematologic malignancies and duration of hospitalization period increases the risk of thrombosis. The objective of this study was to investigate the incidence of and risk factors for venous thrombosis in hospitalized patients with hematologic malignancies. We designed a prospective cohort study and enrolled patients with hematologic malignancies, who had been hospitalized between 2020 and 2021. Thromboprophylaxis was given to all patients, other than those under a high risk of hemorrhage. 94 patients were enrolled. The incidence of superficial vein thrombosis was 11.7% and the incidence of deep vein thrombosis (including pulmonary embolism and catheter thrombosis) was 7.4%. Patients, who developed thrombosis, had statistically significantly longer hospital stays (21 vs. 11.5 days, p=0.023) and a higher number of hospitalizations (1 vs. 3, p=0.015) compared to those, who did not develop thrombosis. Patients, who had 3 or more risk factors for thrombosis, were found to be under the highest risk. (p=0.017, OR=4.32; 95% CI: 1.3-14.35). Furthermore, patients with recurrent hospitalizations (p=0.024, OR=1.49; 95% CI: 1.05-2.11) and higher fibrinogen levels (p=0.028, OR=1; 95% CI: 1-1.006) were under an increased risk of thrombosis. Venous thrombosis is frequently seen in hospitalized patients with hematologic malignancies. A universally accepted risk scoring system is required for detection of patients, under a high risk for thrombosis.

Endovenous laser ablation of great saphenous vein and pharmacotherapy of acute ascending thrombophlebitis: results of a three-month follow-up

Aim. In patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, assess the incidence of venous thrombosis progression over 3 months with 1,5-month fondaparinux sodium therapy and endovenous laser ablation of the saphenofemoral junction in combination with short-term (7-day) anticoagulant therapy or without anticoagulation.Material and methods. This single-center, prospective, randomized, open-label study included data from 91 patients with acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries, of which 30 were in the group of endovenous laser ablation without anticoagulation, 32 — in the group of endovenous laser ablation in combination with 7-day fondaparinux therapy, and 29 — in the 1,5-month fondaparinux therapy group. Venous thrombosis progression rate within 90±2 days was assessed. Compression ultrasonography of lower limb veins was performed on days 7±2, 45±2 and 90±2 after randomization, as well as in case of thrombosis progression suspicion.Results. The mean age of patients was 49,4±14,2 years. There were more women (73,6%). There was a low prevalence of risk factors for the development and progression of venous thrombosis: obesity — 6,6%, type 2 diabetes — in 2 patients, class 2 heart failure — in 1, autoimmune disease (scleroderma in remission) — in 1, prior cancer — in 1. Previous episodes of thrombophlebitis were noted in 3 cases (3,3%). Following external factors provoking venous thrombosis were identified in 19 patients (20,9%): lower leg injury in 14, high physical activity in 3, long flight in 1, recent coronavirus disease 2019 in 1. Median duration of thrombophlebitis manifestations was 6 days. Thrombosis was located in the trunk of the great saphenous vein in 96,7% of patients, while large tributaries were involved in 29,7%. The median distance from the thrombus proximal part to the saphenofemoral junction was 42,5 cm. Over 90±2 days, there were no cases of involvement of the suprafascial segment of the perforating vein in thrombosis to the fascia level, spread of thrombosis to the deep veins, or pulmonary embolism. Subsequently, a new episode of superficial vein thrombosis was noted only in 2 patients from the pharmacotherapy group with a history of thrombophlebitis.Conclusion. In patients with a low risk of venous thrombosis progression and predominantly distal location of acute ascending thrombophlebitis of the great saphenous vein and/or its large tributaries after endovenous laser ablation, progression of venous thrombosis is not expected over the next 3 months, despite an anticoagulation reduction to 7 days or its refusal.

Superficial Vein Thrombosis of the Upper Extremity: Not a Benign Entity

Superficial vein thrombosis receives little medical attention, however it is not an uncommonly encountered presentation. While previously thought to be a completely benign entity, more recent studies have demonstrated that it may be associated with concomitant deep vein thrombosis and thromboembolic complications.1 Additionally, superficial vein thrombosis is not always self-limiting, and can be prone to tenacity and recurrence, causing significant incapacitation and impairment of daily functional activities, especially when involving the upper extremities. We present the case of a 31-year-old woman who developed extensive superficial vein thrombosis of the non-dominant upper extremity following a brief period of peripheral intravenous cannulation. Our reasons for highlighting this case are: 1. This presentation is usually undermined, and the thromboembolic complications associated with it are not recognized as a sequelae of this entity. 2. To create awareness about current treatment guidelines in superficial vein thrombosis.

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report

Good outcome in a rare presentation of simultaneous cerebral superficial and deep venous thrombosis with cortical vein thrombosis post thrombectomy: A case report