The quality of evidence is downgraded by imprecise results (few outcome events).
A Cochrane review [Abstract] 1 included 33 studies with a total of 7 296 subjects with superficial thrombophlebitis (ST) of the legs. Treatment ranged from fondaparinux, rivaroxaban, low molecular weight heparin (LMWH), unfractionated heparin (UFH), non-steroidal anti-inflammatory agents (NSAIDs), compression stockings, and topical, intramuscular, or intravenous treatment to surgical interventions such as thrombectomy or ligation. Only a minority of trials compared treatment with placebo rather than an alternative treatment. Pooling of the data was possible for few outcomes, and none were part of a placebo-controlled trial.
In a placebo-controlled RCT of 3 002 patients, fondaparinux (2.5 mg sc once daily given for 45 days) was associated with a significant reduction in symptomatic venous thromboembolism (VTE; RR 0.15, 95% CI 0.04 to 0.50), extension (RR 0.08, 95% CI 0.03 to 0.22), and recurrence of ST (RR 0.21, 95% CI 0.08 to 0.54) with comparable rates of major bleeding (RR 0.99, 95% CI 0.06 to 15.86) relative to placebo. A total of 88 patients would need to be treated with fondaparinux to prevent one PE or DVT. The results were maintained at the one-month follow-up after discontinuation of treatment. In one RCT on 472 high-risk participants with ST, fondaparinux given for 45 days was associated with a non-significant reduction of symptomatic VTE compared to rivaroxaban 10 mg (RR 0.33, 95% CI 0.03 to 3.18), and there were no major bleeding events in either group. In another placebo-controlled trial, both prophylactic and therapeutic doses of LMWH given for 8 to 12 days (prophylactic RR 0.44, 95% CI 0.26 to 0.74, 1 study, n=222; therapeutic RR 0.46, 95% CI 0.27 to 0.77; 1 study, n=218) and NSAIDs (RR 0.46, 95% CI 0.27 to 0.78; 1 study, n=211) reduced the extension and recurrence of ST in comparison to placebo, with no significant effects on symptomatic VTE or major bleeding. For LMWH, although the differences were not statistically significant, the incidence of VTE tended to be lower both with prophylactic and therapeutic LMWH shortly after treatment but not at the end of the 3-month follow-up period, suggesting a catch-up phenomenon. Topical treatments improved local symptoms compared with placebo, but the studies did not report 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.
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