AUTHOR AND EDITOR INFORMATION

Section 1 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

INTRODUCTION

Section 2 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Background

Thrombosis or thrombophlebitis of the superficial venous system receives little attention in textbooks of surgery and medicine. However, it is encountered frequently and, at times, can cause significant incapacitation. It usually is a benign self-limiting disease, but it can be recurrent and tenaciously persistent. At times, when affecting the greater saphenous vein, thrombophlebitis can progress into the deep venous system, which may lead to pulmonary embolism.

Superficial thrombophlebitis is an inflammatory reaction with thrombus of a vein under the skin. Distinguishing venous thrombosis from venous phlebitis can be challenging. Deep vein thrombosis (phlebothrombosis) can be asymptomatic, which means that thrombosis of the vein can be present without phlebitis. However, most of the veins that develop thrombosis also have phlebitis, thus the term thrombophlebitis. Also, phlebitis usually is associated with thrombosis.

Superficial thrombophlebitis usually is associated with an inflammatory reaction involving the vein. Because of the superficial location, the thrombophlebitis may not respond to anticoagulation in the same manner as a deep vein thrombosis, and it may require different therapy altogether.

Pathophysiology

Although the etiology frequently is obscure, superficial venous thrombosis most often is associated with one of the components of the Virchow triad, ie, intimal damage (which can result from trauma, infection, or inflammation), stasis, or changes in the blood constituents (presumably causing changes in coagulability). Although superficial thrombophlebitis usually occurs in the lower extremities, it also has been described in the penis and the breast (Mondor disease). Superficial thrombophlebitis also occurs anywhere medical interventions occur, such as in the arm or neck (external jugular vein) from intravenous catheters.

Frequency

International

It is a common condition worldwide.

Mortality/Morbidity

Death from superficial thrombophlebitis without complication is unusual; however, if it extends into the deep venous system, it can be the source of pulmonary emboli.

Sex

• Based on the author's experience, this condition occurs slightly more frequently in females than in males.
• McColl and associates charted a possible risk of thrombophilia as a result of pregnancy, which could lead to superficial thrombophlebitis. This is of concern to those women who carry the factor V Leiden or prothrombin C-20210-a genes, in whom a predisposition towards clotting is present.
• Several studies indicate that oral contraceptives can increase the risk of thrombophlebitis. The risk of clotting is not well defined with more recent formulations of oral contraceptives with lower estrogen doses.

Age

• In the author's experience, superficial thrombophlebitis most frequently occurs in the age group ranging from young adults to middle-aged persons.
• However, Markovic and associates report that a common risk factor is age older than 60 years, but fewer complications occur in this age group.

CLINICAL

Section 3 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

History

Types of superficial venous thrombosis are as follows:

• Traumatic thrombophlebitis
• • Superficial venous thrombosis following an injury usually occurs in an extremity, manifesting as a tender cord along the course of a vein juxtaposing the area of trauma. Ecchymosis may be present early in the disease, indicating extravasation of blood associated with injury to the vein, and this may turn to brownish pigmentation over the vein as the inflammation resolves.
  • Thrombophlebitis frequently occurs at the site of an intravenous infusion as a result of the drugs being given or of the intraluminal catheter or cannula itself. This is by far the most common type of thrombophlebitis encountered. Usually, redness and pain signal its presence while the infusion is being given, but thrombosis may manifest as a small lump days or weeks after the infusion apparatus has been removed. It may take months to completely resolve.
  • The features of the iatrogenic form of traumatic (chemical) phlebitis may be deliberately produced by sclerotherapy.
• Thrombophlebitis in a varicose vein
• • Superficial thrombophlebitis frequently occurs in varicose veins. It may extend up and down the saphenous vein or may remain confined to a cluster of tributary varicosities away from the main saphenous vein.
  • Superficial thrombophlebitis along the course of the greater saphenous vein is observed more often to progress to the deep system. Although it may follow trauma to a varix, it often appears to occur without antecedent cause.
  • Thrombophlebitis develops as a tender hard knot in a previously noted varicose vein and frequently is surrounded by erythema. At times, bleeding may occur as the reaction extends through the vein wall. It frequently is observed in varicose veins surrounding venous stasis ulcers.
• Thrombophlebitis as the result of an infection
• • In 1932, DeTakats suggested that dormant infection in varicose veins was a factor in the development of thrombophlebitis occurring at operation or after injection treatments, trauma, or exposure to radiation therapy.
  • Altemeier and colleagues suggested that the presence of L-forms and other atypical bacterial forms in the blood may play an important etiologic role in the disease.
  • Septic phlebitis usually occurs in association with the long-term use of an intravenous cannula inserted for the administration of fluid or medications.
  • Suppurative thrombophlebitis is a more serious, even lethal, complication of intravenous cannulation and therapy and is characterized by purulence within the vein. It frequently is associated with septicemia.
• Thrombosis of a hemorrhoid
• • This is another example of superficial venous thrombosis. Evacuation of the thrombus, although very painful, usually provides rapid relief.
  • Magnesium sulfate compresses also may be used to alleviate swelling and pain.
  • Sometimes, surgery is necessary to remove the clot from the hemorrhoid.
• Migratory thrombophlebitis
• • Jadioux first described migratory thrombophlebitis in 1845 as an entity characterized by repeated thromboses developing in superficial veins at varying sites but most commonly in the lower extremity. Although numerous etiologic factors have been proposed, none has been confirmed.
  • The association of carcinoma was first reported by Trousseau in 1856. Sproul noted migratory thrombophlebitis to be especially prevalent with carcinoma of the tail of the pancreas.
  • Phlebitis occurs in diseases associated with vasculitis, such as polyarteritis nodosa (periarteritis nodosa) and Buerger disease. Buerger noted phlebitis in 8 of 19 patients, and Shionoya reported it in 43% of the 255 patients he followed.
• Thrombophlebitis of the superficial veins of the breast and the anterior chest wall (Mondor disease)
• • Mondor disease is a rare condition. The thrombophlebitis usually is located in the anterolateral aspect of the upper portion of the breast or in the region extending from the lower portion of the breast across the submammary fold toward the costal margin and the epigastrium.
  • A characteristic finding is a tender cordlike structure that may be demonstrated best by tensing the skin by elevating the arm.
  • The cause is unknown, but a search for malignancy is indicated.
  • Thrombophlebitis of the dorsal vein of the penis, generally caused by trauma or repetitive injury, also is referred to as Mondor disease.

Physical

• In each type of superficial thrombophlebitis, the condition presents as redness and tenderness along the course of the vein, usually accompanied by swelling.
• Bleeding also can occur at the site of a varicose vein.
• Superficial thrombophlebitis spontaneously develops in superficial veins, especially in the lower extremities in the greater saphenous vein; this is common in patients with varicose veins.
• Although unusual, it may occur in the lesser saphenous vein, which empties into the popliteal vein.
• Superficial thrombophlebitis of the upper extremities usually occurs at infusion sites or sites of trauma.
• Superficial thrombophlebitis can occur in the external jugular vein if it has been used for an infusion site.

Causes

• Risk factors
• • Varicose veins
  • Obesity
  • Age older than 60 years (fewer complications in this age group)
  • Cigarette smoking
  • Caustic materials, such as lighter fluid and street drugs, injected intravenously
  • Hypercoagulable states such as factor V Leiden mutation, prothrombin gene mutation, and protein S deficiency

DIFFERENTIALS

Section 4 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Other Problems to be Considered

Lymphangitis
Neuritis
Ruptured medial head of the gastrocnemius
Tendonitis

WORKUP

Section 5 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Lab Studies

• Patients who present with spontaneous thrombophlebitis without a previous indwelling intravenous catheter or other precipitating cause should be considered for evaluation for a hypercoagulable state.
• • Certainly, all patients with a past history of another thromboembolic event should undergo a workup. Evaluation should include tests for factor V Leiden and prothrombin gene mutations, protein C and protein S, antithrombin C, antiphospholipid antibodies, lupus anticoagulant, factor VIII, and homocysteine.
  • Schonauer et al reported a high factor VIII concentration to be an independent risk factor for recurrent superficial thrombosis after another episode of venous thromboembolism. de Godoy and Braile reported that 5.5% of patients with repetitive superficial thrombophlebitis were positive for protein S deficiency. Other authors have reported that both factor V Leiden and the prothrombin gene mutation significantly increases the risk of superficial thrombophlebitis.
• Migratory thrombophlebitis, especially without good cause, may be an indication for a more detailed evaluation of the patient in search of a malignant lesion. This also should include selective application of serum carcinoembryonic antigen (CEA), prostate-specific antigen (PSA), colonoscopy, CT scans, and mammography.

Imaging Studies

• Duplex ultrasound evaluation is the diagnostic study of choice to search for venous thrombosis. Thrombosed veins may appear thickened or inflamed on ultrasound, but the most diagnostic finding is a lack of compressibility of the vein using the scan head. An experienced ultrasound technologist should be able to diagnose superficial thrombophlebitis with a high sensitivity and specificity. A key question concerns the location and extent of superficial thrombosis, as well as the proximity to the deep venous system at the saphenofemoral or saphenopopliteal junction. Lutter and associates reported that 12% of 186 patients with superficial thrombophlebitis of the great saphenous vein above the knee had extension into the deep venous system.
• Venography is rarely required to diagnose superficial thrombophlebitis. It should generally be avoided because of the potential complications of intravenous contrast administration, which can itself lead to phlebitis. Venography is not necessary to exclude the diagnosis of deep vein thrombosis, which can be excluded with duplex scanning. If information on the pelvic veins or iliac venous outflow tract is required, CT venography is usually preferable, if available.
• After an initial diagnosis of superficial thrombophlebitis, a follow-up duplex ultrasound examination should be performed to look for progression of disease after treatment is initiated. A finding of no clot extension indicates successful therapy; thrombus extension or encroachment toward the deep venous system should prompt more aggressive treatment.

Procedures

• With persistence or spread of the process, the thrombophlebitic vein may be excised. Patients who demonstrate signs and symptoms of septic thrombophlebitis require urgent vein excision to control the septic focus. This is usually performed through a direct incision over the vein, allowing removal of the infected thrombosed segment along with wide debridement of any surrounding infected or necrotic tissue. Cultures are sent to guide antibiotic therapy.
• Surgical treatment may also be considered for patients with saphenous thrombophlebitis. This is most often considered if the process extends upward toward the femoral vein or popliteal vein despite anticoagulation or in a patient with a contraindication to systemic anticoagulation. Whether surgical ligation or anticoagulation is the best initial treatment for saphenous thrombosis without deep venous involvement remains controversial. If saphenous ligation is chosen, high ligation at the saphenofemoral or saphenopopliteal junction is recommended with ligation of any branches near the junction. For saphenopopliteal procedures, ultrasound mapping for guidance is recommended because of the variability in location of the saphenopopliteal anatomy.
• If a vein segment involved with superficial thrombophlebitis is suspected to be a source of bacteremia but does not require excision, it can be aspirated in order to culture the contents of the vein lumen. This may be helpful in immunocompromised patients with phlebothrombosis and positive blood cultures.

Histologic Findings

Histologic findings include inflammatory reaction in the vein wall and thrombus in the lumen of the vein.

TREATMENT

Section 6 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical Care

The treatment of superficial venous thrombosis depends on its etiology, extent, and symptoms. Duplex scanning gives an accurate appraisal of the extent of disease and thus allows determining more rational therapy.

• For the superficial, localized, mildly tender area of thrombophlebitis that occurs in a varicose vein, treatment with mild analgesics, such as aspirin, and the use of some type of elastic support usually are sufficient. Patients are encouraged to continue their usual daily activities. If extensive varicosities are present or if symptoms persist, phlebectomy of the involved segment may be indicated.
• More severe thrombophlebitis, as indicated by the degree of pain and redness and the extent of the abnormality, should be treated by bedrest with elevation of the extremity and the application of massive, hot, wet compresses. The latter measure seems to be more effective when a large, bulky dressing, including a blanket and plastic sheeting followed by hot water bottles, is used, taking care to avoid burning the patient. The immobilization probably is as beneficial as the moist heat. Long-leg heavy-gauge elastic stockings or multiple elastic (Ace) bandages are indicated when the patient becomes ambulatory.
• Patients who present with thrombosis of the long or short saphenous veins should be considered for anticoagulation or ligation of the saphenous vein. A high incidence (6-44%) of concurrence or progression to deep venous thrombosis has been reported. Ascher et al reported that 65.6% of patients who present with long saphenous vein thrombosis were found to have associated deep vein thrombosis. Optimal treatment of saphenous thrombosis remains controversial. As noted by Wichers et al in a recent systematic review, a lack of randomized trials prevents evidence-based recommendations in this area.
  • In a small randomized trial of 60 patients with long saphenous thrombosis, Lozano et al compared treatment using low molecular weight heparin (LMWH) with surgical saphenous ligation. Patients in the LMWH group experienced no episodes of deep vein thrombosis or pulmonary embolism but had a 10% incidence of recurrent superficial vein thrombosis. Patients treated surgically were found to have 2 pulmonary emboli (6.7%) and 1 episode of recurrent superficial vein thrombosis (3.3%).
  • In a larger randomized trial (Stenox study), 436 patients with superficial vein thrombosis were randomized to placebo treatment compared with nonsteroidal anti-inflammatory drugs (NSAIDs) or 2 doses of LMWH. All patients wore compression stockings. No statistical difference in the incidence of deep vein thrombosis or pulmonary embolism between the groups was found. The placebo group had a higher incidence of recurrent superficial vein thrombosis than the other 3 groups. Interestingly, the group treated with NSAIDs was no different than those treated with LMWH.
  • Wichers et al conclude, after systematic review of the literature, that LMWH or NSAID therapy appears to reduce the incidence of superficial vein thrombosis extension or recurrence. Larger trials are likely required to demonstrate differences in the incidence of deep vein thrombosis. Treating patients with some form of low- or intermediate-dose anticoagulation appears reasonable at this time, followed by repeat duplex ultrasound to look for progression at intervals for a few weeks to a month. In patients with stable nonprogressing thrombus, anticoagulation therapy can probably be discontinued in the absence of other risk factors.
  • Patients with contraindications to anticoagulation or those receiving adequate anticoagulation treatment who have progression of thrombosis should be considered for saphenous ligation at the junction with the deep venous system.
• If the thrombophlebitis is associated with a cannula or a catheter, the device should be immediately removed and cultured. If the patient is septic, appropriate antibiotics should be given. If suppurative thrombophlebitis is suspected, immediate and complete excision of all of the involved veins is indicated. The wound may be left packed open for secondary closure or skin grafting at a later date. The use of appropriate systemic antibiotics always is indicated.
• If the suppurative process involves one of the deep veins, aggressive antimicrobial and anticoagulant therapy are necessary.

Activity

In the early phases of superficial thrombophlebitis in the leg, dangling the extremity without external support from stockings or elastic bandages leads to leg swelling and increased pain.

MEDICATION

Section 7 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Some anti-inflammatory drugs may be of benefit. Salicylates, indomethacin, and ibuprofen have been reported to be effective. Salicylates, ibuprofen, and dipyridamole have been used as antithrombotic agents, but their effectiveness has not been documented in this setting. Because thrombophlebitis primarily is due to inflammation and fibrin clot, antithrombotic or antiplatelet-aggregating agents would seem to have little value. Anticoagulants usually are not indicated unless the process extends into the deep venous system. In rare cases when persistent inflammation is present in an area of superficial thrombophlebitis, a brief course of LMWH can be used as an alternative to excision of the vein in order to bring the inflammation under control. This treatment alternative may be necessary for management of superficial thrombophlebitis associated with pregnancy.

Antibiotics usually are not necessary unless the process is suppurative. In persistent cases or even as early definitive therapy, excision of the inflammatory process is effective. The wounds usually heal well with primary closure; the inflammatory process, except in suppurative phlebitis, usually is nonbacterial and localized and is removed completely.

Drug Category: Nonsteroidal anti-inflammatory drugs

Decrease inflammatory responses and systemically interfere with events leading to inflammation.

Drug Name	Indomethacin (Indochron E-R, Indocin)
Description	Rapidly absorbed; metabolism occurs in liver by demethylation, deacetylation, and glucuronide conjugation; inhibits prostaglandin synthesis.
Adult Dose	25-50 mg PO bid/tid 75 mg SR PO bid; not to exceed 200 mg/d
Pediatric Dose	1-2 mg/kg/d divided PO bid/qid; not to exceed 4 mg/kg/d or 150-200 mg/d
Contraindications	Documented hypersensitivity; GI bleeding or renal insufficiency
Interactions	Coadministration with aspirin increases risk of inducing serious NSAID-related adverse effects; probenecid may increase concentrations and, possibly, toxicity of NSAIDs; may decrease effect of hydralazine, captopril, and beta-blockers; may decrease diuretic effects of furosemide and thiazides; monitor PT closely (instruct patients to watch for signs of bleeding); may increase risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently
Pregnancy	B - Usually safe but benefits must outweigh the risks.
Precautions	Category D in third trimester of pregnancy; acute renal insufficiency, hyperkalemia, hyponatremia, interstitial nephritis, and renal papillary necrosis may occur; increases risk of acute renal failure in patients with preexisting renal disease or compromised renal perfusion; reversible leukopenia may occur (discontinue if persistent leukopenia, granulocytopenia, or thrombocytopenia occur)

FOLLOW-UP

Section 8 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Further Outpatient Care

• Follow up in 2-3 days, either with an office visit or by telephone, to be sure the patient is progressing in a satisfactory manner.

Complications

• Extension into the deep venous system
• Complications of suppurative phlebitis include the following:
• • Metastatic abscess formation
  • Septicemia
• Hyperpigmentation over the affected vein
• Persistent firm nodule in subcutaneous tissues at site of affected vein

Prognosis

• The prognosis usually is good.
• Superficial phlebitis rarely is associated with pulmonary embolism, although it can occur, particularly if the process extends into a deep vein.
• • Individuals with superficial venous thrombosis do not seem to have a great tendency to develop deep venous thrombosis; however, duplex scanning may prove this assumption wrong.
  • Superficial venous thrombosis, on the other hand, does occur frequently in association with deep venous thrombosis, especially in patients with ulceration around the ankle.
• The patient should be told to expect the disease process to persist for 3-4 weeks or longer. If it occurs in the lower extremity in association with varicose veins, it has a high likelihood of recurrence unless excision is performed.

Patient Education

• Because thrombophlebitis tends to recur if the vein has not been excised, instructing the patient in ways to prevent stasis in the vein usually is advisable.
• • The use of elastic stockings may be indicated, especially if the patient plans to stand in an upright position for long periods.
  • Slight elevation of the foot of the bed, avoidance of long periods of standing in an upright position, or inactivity is recommended.
• For excellent patient education resources, visit eMedicine's Circulatory Problems Center. Also, see eMedicine's patient education articles Varicose Veins, Blood Clot in the Legs, and Phlebitis.

MISCELLANEOUS

Section 9 of 10  

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

Medical/Legal Pitfalls

• Failure to perform duplex scanning in the presence of superficial thrombophlebitis to exclude deep vein thrombophlebitis

REFERENCES

Section 10 of 10

• Authors and Editors
• Introduction
• Clinical
• Differentials
• Workup
• Treatment
• Medication
• Follow-up
• Miscellaneous
• References

• Altemeier WA, Hill EO, Fullen WD. Acute and recurrent thromboembolic disease: a new concept of etiology. Ann Surg. Oct 1969;170(4):547-58. [Medline].
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• Bird V, Krasnokutsky S, Zhou HS, et al. Traumatic thrombophlebitis of the superficial dorsal vein of the penis: an occupational hazard. Am J Emerg Med. Jan 1997;15(1):67-9. [Medline].
• Blumenberg RM, Barton E, Gelfand ML, et al. Occult deep venous thrombosis complicating superficial thrombophlebitis. J Vasc Surg. Feb 1998;27(2):338-43. [Medline].
• Buerger L. The veins in thromboangiitis obliterans: With particular reference to arteriovenous anastomosis as a cure for the condition. JAMA. 1909;52:1319.
• Cranley JJ. Thrombophlebitis in obstetrics and gynecology. In: Rakel RE, ed. Conn's Current Therapy. Philadelphia, Pa: WB Saunders; 1984.
• DeTakats G. "Resting Infection" in varicose veins, its diagnosis and treatment. Am J Med Sci. 1932;184:57.
• Glasser ST. Principles of Peripheral Vascular Surgery. Philadelphia, Pa: FA Davis; 1959.
• Gorski G, Szopinski P, Michalak G. Liposomal heparin spray: a new formula in adjunctive treatment of superficial venous thrombosis. Angiology. 2005;56:9-17.
• Johnson G, DePalma RG. Superficial thrombophlebitis: diagnosis and management. In: Rutherford's Vascular Surgery. Vol 1. 5th ed. Philadelphia, Pa: WB Saunders; 1998:. 1979, section XIX.
• Lozano FS, Almazan A. Low molecular weight heparin versus saphenofemoral disconnection for the treatment of above knee greater saphenous thrombophlebitis: a prospective study. Vasc Endovascular Surg. 2003;37:415-20.
• Lutter KS, Kerr TM, Roedersheimer LR. Superficial thrombophlebitis diagnosed by duplex scanning. Surgery. Jul 1991;110(1):42-6. [Medline].
• Marchiori A, Veriato F, Sabbion P. High versus low doses of unfractionated heparin for the treatment of superficial thrombophlebitis of the leg: A prospective, controlled, randomized study. Hematologica. 2002;87:523-7.
• Markovic MD, Lotina SI, Davidovic LB, et al. [Acute superficial thrombophlebitis--modern diagnosis and therapy]. Srp Arh Celok Lek. Sep-Oct 1997;125(9-10):261-6. [Medline].
• McColl MD, Ramsay JE, Tait RC, et al. Superficial vein thrombosis: incidence in association with pregnancy and prevalence of thrombophilic defects. Thromb Haemost. Apr 1998;79(4):741-2. [Medline].
• Neher JO, Safranek S. What is the best therapy for superficial thrombophlebitis?. J Fam Pract. Jul 2004;53(7):583-5; discussion 584. [Medline].
• Prandoni P, Tormene D, Pesavento R, Vesalio Investigators Group. High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomized trial. J Thromb Haemost. Jun 2005;3(6):1152-7.
• Quenet S, Laporte S, Decousus H, et al. Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. J Vasc Surg. Nov 2003;38(5):944-9.
• Rush MD, Schoenfeld CN, Watson WA, et al. Skin necrosis and venous thrombosis from subcutaneous injection of charcoal lighter fluid (naptha). Am J Emerg Med. Sep 1998;16(5):508-11. [Medline].
• Schonauer V, Kyrle PA, Weltermann A. Superficial thrombophlebitis and risk for recurrent venous thromboembolism. J Vasc Surg. Apr 2003;37(4):834-8. [Medline].
• Shionoya S. Buerger's Disease: Pathology, Diagnosis and Treatment. Nagoya, Japan: University of Nagoya Press; 1990.
• Sproul EE. Carcinoma and venous thrombosis: Frequency of association of carcinoma in body or tail of pancreas with multiple venous thrombosis. Am J Cancer. 1938;34:566.
• Superficial Thrombophlebitis Treated by Enoxaparin Study Group. A pilot randomized double-blind comparison of a low-molecular-weight heparin, a nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis. Arch Intern Med. Jul 28 2003;163(14):1657-63.
• Wichers IM, Di Nisio M, Buller HR, Middeldorp S. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica. May 2005;90(5):672-7.
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Article Last Updated: Sep 29, 2006