Superficial Thrombophlebitis and Low-Molecular-Weight Heparins

The current status of superficial thrombophlebitis, including incidence, diagnosis, and management, are reviewed. Treatment options are assessed in the light of data from the main studies reported in the literature. These include compression, ambulation, and nonsteroidal antiinflammatory agents and surgical management with high saphenous ligation (with or without saphenous vein stripping) with or without anticoagulants, ranging from aspirin, unfractionated heparin, warfarin, and low-molecular-weight heparin (LMWH). The advantage of the surgical approach is that by ligation with or without stripping of the superficial veins the underlying pathesis (i.e., varicose veins) is also eradicated. In the presence of deep venous thrombosis (DVT), surgery could be combined with anticoagulants. The extensive current literature for DVT treatment shows that the LMWHs are at least as effective and safe as the unfractionated heparins. On this basis, one could reasonably recommend LMWH for the treatment of superficial thrombophlebitis with involvement of the deep veins. Pentasaccharide, a drug that has been recently explored for the prophylaxis and treatment of DVT could be another option. However, there are as yet no data for recommended dosages or duration of treatment for the latter two options.