Pathways for lower extremity superficial vein thrombosis management in an academic medical center

Submitted: 27 September 2024
Accepted: 28 February 2025
Published: 24 March 2025
Abstract Views: 41
PDF: 2
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Authors

There is currently no established management pathway for lower extremity superficial vein thrombosis (SVT), leading to significant uncertainty among front-line providers. This study aimed to assess prescribing practices and patient outcomes for the initial treatment of lower extremity SVT. This descriptive retrospective cohort study in a single center included consecutive patients with radiographically diagnosed acute lower extremity isolated SVT between January 1, 2016 and December 31, 2021. Exclusions were chronic SVT, concomitant deep vein thrombosis or pulmonary embolism, required anticoagulation for another indication, or no documented SVT treatment plan. This 6-year study included 265 patients. The majority received conservative therapy as the SVT management strategy (n=188, 70.9%), while 23% (n=61) received anticoagulation therapy. Few patients received no treatment (n=13, 4.9%) or surgery (n=3, 1.1%). The most common strategy in those utilizing anticoagulation was a VTE treatment-dose DOAC, but the duration varied considerably (11.5% 30 days or less, 37.7% 31-45 days, 21.3% for 46-90 days, and 24.6% >90 days). Ninety-day progression to VTE occurred in 8 patients (3.1%, 2 in the anticoagulation therapy group and 6 in the conservative therapy group). Bleeding occurred in 6 patients (2.3%, 4 in the conservative therapy group and 2 in the anticoagulation group).  Over a six-year period, there were varying pathways of managing acute lower extremity SVT without a concerning signal in adverse events with any single treatment approach. Future study should focus on which patients benefit from anticoagulation therapy vs conservative therapy and clarifying the optimal anticoagulation treatment intensity and duration.

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Citations

1. Scovell SD, Ergul EA, Conrad MF. Medical management of acute superficial vein thrombosis of the saphenous vein. J Vasc Surg Venous Lymphat Disord 2018;6:109-17. DOI: https://doi.org/10.1016/j.jvsv.2017.08.016
2. Stevens SM, Woller SC, Kreuziger LB, et al. Antithrombotic therapy for VTE disease: Second update of the CHEST guideline and expert panel report. Chest 2021;160:e545-e608. DOI: https://doi.org/10.1016/j.chest.2021.07.055
3. Ortel TL, Neumann I, Ageno W, et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020;4:4693-38. DOI: https://doi.org/10.1182/bloodadvances.2020001830
4. Decousus H, Prandoni P, Mismetti P, et al. Fondaparinux for the treatment of superficial-vein thrombosis in the legs. N Engl J Med 2010;363:1222-32. DOI: https://doi.org/10.1056/NEJMoa0912072

Ethics approval

this study was approved by the University of Utah Institutional Review Board

How to Cite

Imani, G., Wilson, A., Vazquez, S., & Witt, D. M. (2025). Pathways for lower extremity superficial vein thrombosis management in an academic medical center. Bleeding, Thrombosis and Vascular Biology, 4(1). https://doi.org/10.4081/btvb.2025.155

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