Medical treatment of superficial thrombophlebitis of the lower limb: heparin or anti-inflammatory?

Botas, Philippe; Pimenta, José; Santos, Pedro; Santiago, Luiz Miguel

http://hdl.handle.net/10400.26/8007

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Authors

Botas, Philippe

Pimenta, José

Santos, Pedro

Santiago, Luiz Miguel

Abstract(s)

Abstract: Objectives The objective of this review is to clarify the best treatment for superficial thrombophlebitis (ST) of the lower limb (LL), regarding nonsteroidal anti-inflammatory drugs (NSAIDs) and low-molecularweight heparin (LMWH). Data sources Pubmed database, evidence-based medicine websites, General Directorate of Health, Portuguese Association of General Practitioners, MGFamiliar.net, Index of Portuguese Medical Magazines. Review methods Research of clinical guidelines (CG), Systematic reviews (SR) and original studies using the MeSH terms: venous thrombosis; heparin, low-molecular-weight; anti-inflammatory agents. The search was limited to articles published between 2008 and 2011. Exclusion criteria were: repeated articles; ST during hospital admittance; ST not in the LL; pediatric ST; ST prophylaxis; Complicated ST; Risk factor related ST. American Family Physician’s Strength of Recommendation Taxonomy (SORT) was used to assess the level of evidence. Results 215 articles were obtained. We have selected one CG, two SR and one randomized clinical trial (RCT). Evidence supports that there is improvement in patients’ symptoms with ST treated with LMWH or NSAIDs compared with placebo, reducing the incidence of recurrences and complications, without differences in safety profile in the short term. The evidence also highlights the anticoagulation as first-line therapy. The simultaneous use of NSAIDs and LMWH showed greater efficacy in symptomatic relief than LMWH alone in a RCT. Conclusions LMWH and NSAIDs are the two options with evidence supporting its use as first-line treatment (SOR B). Anticoagulation for at least 4 weeks is indicated especially when severity criteria are identified (SOR B). More randomized clinical trials are needed, particularly regarding the choice between LMWH or NSAIDs or its’ simultaneous use, doses and treatment’s length.