Superficial thrombophlebitis of the legs: A randomized, controlled, follow-up study

The aim of the present study was to evaluate the effects of different treat ment plans (compression only, early surgery, low-dose subcutaneous heparin [LDSH], low-molecular-weight heparin [LMWH], and oral anticoagulant [OC] tr eatment) in the management of superficial thrombophlebitis (STP), by consid ering efficacy and costs in a 6-month, randomized, follow-up trial. Patient s with STP, with large varicose veins without any suspected/documented syst emic disorder, were included. Criteria for inclusion were as follows: prese nce of varicose veins; venous incompetence (by duplex); a tender, indurated cord along a superficial vein; and redness and heat in the affected area. All patients were ambulatory. Exclusion criteria were obesity, cardiovascul ar or neoplastic diseases, bone/joint disease, problems requiring immobiliz ation, and age > 70 years. Patients with superficial thrombophlebitis witho ut varicose veins and patients under treatment with drugs at referral were also excluded. Color duplex (CD) was used to detect concomitant deep vein t hrombosis (DVT) and to evaluate the extension or reduction of STP at 3 and 6 months. Venography was not used. Of 562 patients included , 3.5% had had a recent DVT in the same limb affected by SVT and 2.1% in th e contralateral limb. In six patients DVT was present in both limbs.These p atients were treated with anticoagulants and excluded from the follow-up. A fter 3 and 6 months the incidence of STP extension was higher in the elasti c compression and in the saphenous ligation groups (p < 0.05). There was no significant difference in DVT incidence at 3 months among the treatment gr oups. Stripping of the affected veins was associated with the lowest incide nce of thrombus extension. The cost for compression alone was the lowest an d the cost including LMWH was the highest. The average cost was 1,383 US$. However the highest social cost (lost working days, inactivity) was observe d in subjects treated only with stockings.