Treatment of Superficial Vein Thrombosis: A Systematic Review and Meta-Analysis

This meta-analysis calculated that superficial thrombosis occurring in the lower extremity was associated with a 10% rate of deep vein thrombosis and/or PE. Treatment with fondaparinux (Arixstra) lowered the risk to 1.4%. They found insufficient evidence to support other treatments. James W. Mold, MD, MPH

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BACKGROUND:

The optimal first line treatment for patients with isolated superficial venous thrombosis (SVT) of the lower extremity is unknown.

OBJECTIVE:

This article reports estimates of the rate of venous thromboembolic complications among patients with SVT according to treatment.

MATERIALS AND METHODS:

A systematic review and meta-analysis was performed using unrestricted searches of electronic databases. Reported events were transformed to event per 100 patient-years of follow-up and a random effects model was used to calculate pooled rates according to pre-specified treatment categories. The primary outcome was the occurrence of deep vein thrombosis (DVT) or pulmonary embolism (PE) during the study follow-up period.

RESULTS:

Seventeen articles, including 6,862 patients, were included in the meta-analysis. Fondaparinux had the lowest event rate with 1.4 events per 100 patient-years of follow-up (95% confidence interval [CI], 0.5-2.8, I 2 = 18%). Pooled event rates for DVT or PE ranged from 9.3 to 16.6 events per 100 patient-years across other treatment categories, and the pooled event rate for no treatment/placebo was 10.5 events per 100 patient-years (95% CI, 3.0-22.0). Major bleeding was low and similar across all treatment categories. Heterogeneity was moderate to high for most pooled estimates.

CONCLUSION:

While pooled event rates suggest that fondaparinux achieves the lowest rate of DVT or PE, low-quality evidence for other treatments prevents firm conclusions about the optimal treatment for SVT.

Author/s:

Duffett, Lisa, Kearon, Clive, Rodger, Marc, Carrier, Marc