Which treatments are effective in reducing the risk of recurrent superficial venous thrombosis?

Updated: Apr 17, 2019
  • Author: Khanjan H Nagarsheth, MD, MBA; Chief Editor: Vincent Lopez Rowe, MD  more...
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Answer

In a small, randomized trial of 60 patients with GSV thrombosis, Lozano et al compared treatment using LMWH with surgical saphenous ligation. [31] Patients in the LMWH group experienced no episodes of DVT or PE but had a 10% incidence of recurrent superficial venous thrombosis. Among the patients treated surgically, two pulmonary emboli (6.7%) were found, and one episode of recurrent superficial venous thrombosis (3.3%) occurred.

In a larger randomized trial (Stenox study), no statistical difference in the incidence of DVT or PE was found between patients with superficial venous thrombosis who were treated with placebo, with NSAIDs, or with two doses of LMWH. In the study, 436 patients were randomized to one of the three groups; all patients wore compression stockings.

The study’s placebo group had a higher incidence of recurrent superficial venous thrombosis than did the other patients. Interestingly, the results in the group treated with NSAIDs were the same as those in the patients treated with LMWH.

Similar to the outcome of the above study, Wichers et al concluded, after a systematic review of the literature, that LMWH or NSAID therapy appears to reduce the incidence of superficial venous thrombosis extension or recurrence. [16] Larger trials are likely required to demonstrate differences in the incidence of DVT.

Treating patients with some form of low- or intermediate-dose anticoagulation appears reasonable at this time; this should be followed by repeat duplex ultrasonography to look for progression at regular intervals for a few weeks to a month. In patients with stable nonprogressing thrombus, anticoagulation therapy can probably be discontinued in the absence of other risk factors.


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