Superficial venous thrombosis
Questionnaire/history:
Pain, erythema and on palpation tender and hard vein (‘cord-like’)?
Past medical history?
- Risk factors for progression?
---- Previous DVT/PE/SVT?
---- Cancer?
---- Pregnancy?
---- Hormonal therapy?
---- Recent surgery or trauma?
Current medication?
Known drug allergies?
Management:
Isolated SVT which extends to within 3 cm of sapheno-femoral junction (SFJ): anticoagulation as per DVT
Isolated SVT > 5 cm in length located > 3 cm from SFJ: prophylactic fondaparinux 2.5 mg SC OD OR rivaroxaban 10 mg PO OD for 45 days
Isolated SVT < 5 cm in length located > 3cm from SFJ AND risk factors for progression (see above): prophylactic fondaparinux 2.5mg SC OD OR rivaroxaban 10mg PO OD for 45 days
Isolated SVT < 5 cm in length located > 3cm from SFJ + NO risk factors for progression: oral or topical NSAID
· Risk factors for progression:
o previous DVT/PE/SVT
o cancer
o pregnancy
o hormonal therapy
o recent surgery or trauma
(Notes:
Can be serious with a risk of DVT and pulmonary embolism:
- 6-44% have been reported to have an associated DVT
- 20-33% to have asymptomatic PE
- 2-13% to have symptomatic PE
- Future risk of a DVT significantly increased (four to sixfold) (risk highest if SVT in the main trunk of the great saphenous vein and more likely if close to the junctions between the superficial and deep venous systems i.e. near the sapheno-femoral junction on the upper anterior thigh or sapheno-popliteal junction behind the knee)
Resource(s):
British Journal Haematology 2015