Treatment of Superficial Venous Thrombosis

Treatment of the majority of superficial venous thrombosis is based on the results of the excellent CALISTO trial : Treatment with fondaparinux 2.5 mg once daily for 45 days is recommended. However, some patients require therapeutic-dose anticoagulation, including : o concomitant deep vein thrombosis (DVT) occurring with SVT, o extension of the thrombus to the saphenofemoral junction or to a perforating vein, o extensive SVT despite prophylactic-dose anticoagulation. o An SVT longer than 5 cm in a patient with cancer may also justify therapeutic-dose anticoagulation. Surgery has no role as an emergency treatment (except in rare cases where anticoagulation is contraindicated). For other patients, the question of extending anticoagulant therapy arises. There are risk factors for thromboembolic events within 3 months. These factors should be known: o Hospitalized patients o Male sex o History of cancer or active cancer o Involvement of the saphenofemoral or saphenopopliteal junction o Prior history of DVT or PE o Severe chronic venous insufficiency o Extensive superficial venous thrombosis under treatment o Prior SVT o Thrombus length A carefully selected population of patients presenting with several of these risk factors may benefit from extending fondaparinux 2.5 mg once-daily therapy to 3 months. A rigorous diagnostic and therapeutic approach is therefore essential to ensure that each patient receives the treatment that most appropriately optimizes the benefit-risk balance of anticoagulant therapy.