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By continuing to browse this site you agree to us using cookies as described in About Cookies. The optimal treatment of superficial thrombophlebitis ST of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism VTEwhich might complicate the natural history of ST. This is the second update of a review first published in To assess the efficacy and safety of topical, medical, and surgical treatments in patients presenting with ST of Plots von Thrombophlebitis legs.
We handsearched the reference lists of relevant papers and conference proceedings. Randomised controlled trials RCTs evaluating topical, medical, and surgical treatments for ST of the legs that included participants with a clinical diagnosis of ST of the legs or objective diagnosis of a thrombus in a superficial vein. Two authors assessed the trials for inclusion in the review, extracted the data, and assessed the quality of the studies.
Data were independently extracted from the included studies and any disagreements resolved by consensus, Plots von Thrombophlebitis.
We identified four additional trials patients Plots von Thrombophlebitis, so this update considered 30 studies involving participants with ST of the legs. Treatment ranged from fondaparinux, low molecular weight heparin LMWHunfractionated heparin UFHnon-steroidal anti-inflammatory agents NSAIDstopical treatment, Plots von Thrombophlebitis, oral treatment, Plots von Thrombophlebitis treatment, and intravenous treatment to surgery.
Only a minority of trials compared treatment with placebo rather than an alternative treatment, Plots von Thrombophlebitis, none evaluated Plots von Thrombophlebitis same treatment comparisons on the same study outcomes which precluded meta-analysisand many of the studies were small and of poor quality.
Overall, topical treatments improved local symptoms compared with placebo but no data were provided on the effects on VTE and ST extension. Surgical treatment combined with elastic stockings was associated with a lower VTE rate and ST progression compared with elastic stockings alone. However, the majority of studies that compared different oral treatment, Plots von Thrombophlebitis, topical treatment, or surgery did not report VTE, ST progression, adverse events, or treatment side effects.
Prophylactic dose fondaparinux given for 45 days appears to be a valid therapeutic option for ST of the legs. The evidence on oral treatments, Plots von Thrombophlebitis, topical treatment, or surgery is too limited and does not inform clinical practice about the effects of these treatments in terms of VTE and ST progression, Plots von Thrombophlebitis.
Further research is needed to assess the role of the new oral direct thrombin and activated factor-X inhibitors, LMWH, and NSAIDs; the optimal doses and duration of treatment; and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments.
Superficial thrombophlebitis ST is a relatively common inflammatory process associated with a blood clot thrombus that affects the superficial veins. Symptoms and signs include local pain, itching, tenderness, Plots von Thrombophlebitis, reddening of the skin, and hardening of the surrounding tissue. Treatment aims to relieve the local symptoms and to prevent the extension of the clot into a deep vein, ST recurrence, or the development of more serious events caused by VTE.
This review included 30 randomised controlled trials involving participants. Treatment ranged from subcutaneous injections of fondaparinux to low molecular weight heparin, unfractionated heparin, oral non-steroidal anti-inflammatory drugs NSAIDsPlots von Thrombophlebitis, topical treatment, and surgery.
One large study, accounting for half of the patients included in the review, Plots von Thrombophlebitis, showed that treatment with fondaparinux for 45 days was associated with a significant reduction in symptomatic VTE, ST extension, and recurrence of ST with no increase in bleeding relative to placebo.
Plots von Thrombophlebitis treatments relieved local symptoms but the trials did not report on progression to VTE. Surgical treatment and wearing elastic stockings were associated with a lower rate of Plots von Thrombophlebitis and progression of the ST compared with elastic stockings alone, Plots von Thrombophlebitis.
The methodological quality of most of the trials was poor, Plots von Thrombophlebitis. Fondaparinux appears to be an adequate treatment option in patients with ST. Further research is needed to assess the role of low molecular Plots von Thrombophlebitis heparin or NSAIDs and to demonstrate the efficacy, if any, of oral treatments, topical treatment, or wie viel an seinem Bein nach der Operation von Krampfadern Verband in terms of VTE and ST progression.
The term superficial thrombophlebitis STalso known as superficial venous thrombosis, refers to a pathological Plots von Thrombophlebitis characterized by an inflammatory-thrombotic process in a superficial vein. Distinctive clinical findings include pain and a reddened, warm, tender cord extending along the vein. The surrounding area may show signs of erythema reddening of the skin and oedema swelling of the tissue, Plots von Thrombophlebitis.
ST is a relatively common disease and although its incidence has never been properly determined it is estimated to be higher than that of deep vein thrombosis DVTwhich is about 1 per cases De Weese ; Nordstrom Predisposing risk factors for ST and venous thromboembolism VTE are similar and include varicose veins, immobilization, trauma, postoperative states, pregnancy, Plots von Thrombophlebitis, puerperium the period immediately following childbirthactive malignancy, Plots von Thrombophlebitis, auto-immune diseases, use of oral contraceptives or hormonal replacement therapy, advanced age, obesity, and a history of previous VTE Barrelier ; Bergqvist ; Chengelis ; de Moerloose ; Lutter ; Samlaska b.
Furthermore, Plots von Thrombophlebitis, the presence of inherited thrombophilia a disorder where there is a tendency for Plots von Thrombophlebitis to occur, Plots von Thrombophlebitis, for example factor V Leiden, the prothrombin A mutation, Plots von Thrombophlebitis, and deficiencies of the natural anticoagulant proteins C and S in ST suggests a similar pathophysiology as VTE de Moerloose ; Hanson ; Martinelli ; Samlaska a ; Samlaska b.
The variations in estimates reported in the literature are probably due to the retrospective design of most studies, the small number of participants included, and the fact that ST was often diagnosed in vascular laboratories where patients were referred for suspected DVT. There is no consensus on the optimal treatment of ST in Plots von Thrombophlebitis practice.
Several therapies have been proposed in the literature, including surgical therapy ligation or stripping of the affected veinselastic stockings, non-steroidal anti-inflammatory drugs NSAIDs which aim to reduce pain and inflammation, and several anticoagulant agents. For great saphenous ST, Plots von Thrombophlebitis, high saphenous ligation crossectomy would be the emergency surgical treatment option.
It is not clear whether different locations of ST may influence the choice of treatment. The thrombus location in trunks of either the great saphenous vein saphena magna or small saphenous vein saphena parva may have the highest risk of extension into the deep vein system and thus could require an aggressive form of treatment, whereas other locations may be associated with a lower risk of extension and thus may warrant a less aggressive approach.
While the estimates of VTE prevalence in patients with ST vary, management of ST should consider the prevention of this scaring complication beyond the mere resolution of local symptoms Decousus ; Wichers Conservative management, mainly focusing on the painful symptoms of disease, Plots von Thrombophlebitis, might therefore be insufficient. While provision of adequate treatment for ST may help prevent fatal VTE, Plots von Thrombophlebitis, the efficacy of the intervention needs to be balanced against the risks, such as major bleeding events with anticoagulants.
To review the efficacy and safety of topical, medical, and Plots von Thrombophlebitis treatments for ST of the leg in improving local symptoms and decreasing thromboembolic complications. Randomised controlled trials RCTs evaluating topical, medical, and surgical treatments for ST of the legs.
Plots von Thrombophlebitis and non-hospitalised participants with a diagnosis of ST of the lower extremities based on signs and symptoms of ST for example pain, tenderness, induration hardening of the tissueor erythema reddening of the skin in a superficial vein and clinical signs palpationand objective diagnosis of the thrombus in the superficial vein by means of ultrasound scanning of the lower limbs that excludes any concomitant DVT.
Interventions included any treatment to relieve the symptoms and signs or to prevent complications of ST, such as topical treatments, compression stockings, compression bandages, leg elevation, medical treatments for example NSAIDs or anticoagulants such as fondaparinux, low molecular weight heparin LMWHand surgical intervention for example ligation, vein stripping, crossectomy. Each treatment could be compared with another form of treatment, placebo, or no intervention. Combinations of therapies could be used, Plots von Thrombophlebitis.
We included RCTs assessing any of the following outcome measures for any of the reviewed interventions. We searched for RCTs Plots von Thrombophlebitis any treatment versus placebo or another treatment Plots von Thrombophlebitis patients with ST of the legs.
There was no restriction on language. The full list of the databases, journals, and conference proceedings which have been searched, as well as the search strategies used, are described in the Specialised Register section of the Cochrane Peripheral Vascular Diseases PVD Group module in The Cochrane Library www. We searched reference lists of relevant papers and conference proceedings of the International Society for Thrombosis and Hemostasis to and American Society of Haematology toand we attempted to contact known experts in the field.
Two authors MDN and IMW independently reviewed titles and abstracts identified from the database searches to determine whether the inclusion criteria were satisfied. Two authors MDN and IMW independently assessed trials for inclusion in the review, and any disagreement was resolved through discussion or involvement of a third review author SM. We independently reviewed the full text of identified articles, including those where there was disagreement in the initial title or abstract scanning, Plots von Thrombophlebitis, to ensure that the inclusion criteria were met.
We obtained hard copies of the full text of studies that fulfilled the selection criteria. We were not blinded to the journal, institution, or results of the study. Titles and abstracts of non-English articles were translated into English and assessed for inclusion.
We documented reasons for excluding studies and resolved disagreements by consensus. One author MDN scanned conference proceedings, identified articles from other sources experts or reference listsand contacted trialists for further information if required. We resolved any disagreements by consensus and, if necessary, by the involvement of the third review author SM.
For any study published twice, we extracted the data from the more complete study. Collected information included methodological quality, characteristics of patients, Plots von Thrombophlebitis, type of intervention and control, and outcomes. Plots von Thrombophlebitis review authors independently assessed randomisation, blinding, and adequacy of analyses Juni Disagreements were resolved by consensus. Two components of randomisation were assessed: Generation of allocation sequences was considered adequate if it resulted in an unpredictable allocation schedule, Plots von Thrombophlebitis.
Mechanisms considered adequate included random-number tables, computer-generated random numbers, minimisation, coin tossing, shuffling cards, and drawing lots, Plots von Thrombophlebitis.
Trials using an unpredictable allocation sequence were considered randomised. Trials using potentially predictable allocation mechanisms, such as alternation or the allocation of patients according to date of birth, were considered quasi-randomised. Concealment of allocation was considered adequate if patients and investigators responsible for patient selection were unable to predict, before allocation, which treatment was next.
Methods considered adequate included central Plots von Thrombophlebitis pharmacy-controlled randomisation using identical pre-numbered containers; and sequentially numbered, sealed, Plots von Thrombophlebitis, opaque envelopes.
Blinding of patients and therapists was considered adequate if experimental and control preparations were explicitly described as indistinguishable or if a double-dummy technique was used. Assessors were considered blinded if this was explicitly mentioned by the investigators. Analyses were considered adequate if all randomised patients were included in the analysis according to the intention-to-treat principle.
The item 'free of selective reporting' was classified as at 'low risk of bias' if we had both the protocol and the full report of a given study, where the full report presented results for all outcomes listed in the protocol. We classified a study as at 'high risk of bias' if a report did not present data on all outcomes reported in either the protocol or the methods section.
The risk of bias item 'free of other bias' was not considered in this review. We assessed the reporting of primary outcomes and sample size calculations. We planned to use GRADE to describe the quality of the overall body of evidence Guyatt ; Higgins ; however, Plots von Thrombophlebitis, due to the heterogeneity between the studies in terms of treatment comparisons and study outcomes the GRADE approach was considered not informative and therefore omitted from the review.
Prior to obtaining the global effect estimators a balanced mean of the effect in different trialswe planned to evaluate the heterogeneity of treatment effects between trials using the I 2 statistic Higginswhich describes the percentage of total variation across trials that is attributable to heterogeneity rather than chance.
In the presence of no or low heterogeneity, we planned to use the fixed-effect model Mantel-Haenszel method Plots von Thrombophlebitis the random-effects model to pool and Plots von Thrombophlebitis summary effect sizes.
Where possible, we presented results as summary relative risks RR for dichotomous variables and standardised mean differences SMD for all continuous variables. Where possible, we analysed the results by intention to treat, including every individual in the randomly assigned treatment group regardless of whether they completed the treatment or withdrew from the trial, Plots von Thrombophlebitis. We evaluated publication bias and other biases related to small study size using funnel plots, plotting effect sizes on the vertical axis against their standard errors on the horizontal axis.
We assessed asymmetry by the asymmetry coefficient: Symmetry would be expected in the absence of any bias related to small study size. See Characteristics of included studies ; Characteristics of excluded studies. Following screening of titles and abstracts if available full copies of five reports relating to five studies were obtained. Of these, four studies met the review inclusion criteria Belcaro ; Cosmi ; Rathbun ; Winter One study could be retrieved only as an abstract and it is still awaiting classification Bijuan Four additional studies were included in the updated review Belcaro ; Cosmi ; Rathbun ; Winter and in total 30 studies involving participants were included in the review Andreozzi ; Anonymous ; Archer ; Belcaro ; Belcaro ; Belcaro ; Belcaro ; Cosmi ; Decousus a ; De Sanctis ; Plots von Thrombophlebitis ; Gorski ; Holzgreve ; Incandela ; Katzenschlager ; Koshkin ; Kuhlwein ; Lozano ; Marchiori ; Marshall ; Messa ; Nocker ; Nusser ; Pinto ; Rathbun ; Stenox Group ; Titon ; Uncu ; Vesalio Group ; Winter One study is still ongoing Rabe In nine studies data were reported for 50 patients or less, in eleven trials patients were between 50 to patients, and in ten studies data were available for patients or more.
Interventions and comparisons varied greatly among the studies.
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