Therapeutic goals
- Pain relief
- Prevention of pulmonary embolism (vascular occlusion of pulmonary arteries) and post-thrombotic syndrome (chronic venous congestion affecting the lower extremity as a result of deep vein thrombosis)
Note: Therapy must be guided primarily by the duplex sonographic findings, i.e., the extent and location of the thrombus.
Therapy recommendations
- Analgesia (analgesics/pain relievers) (Note: removal of thrombotic material by stab incision (small incision across the skin) often results in rapid pain relief).
- Local cooling and compression if deep vein thrombosis (DVT) is safely ruled out and the thrombus extends <5 cm in small caliber lateral veins.
- Thromboprophylaxis (measures to prevent thrombosis):
- Low-molecular-weight heparins (NMH) or fondaparinux; therapy control in individual cases (e.g., gravidity) via anti-Xa activity (target range for single administration 1.0-2.0 E/ml, for double administration 0.6-1.0 E/ml, each 3-4 h after s.c. injection)Indications: Extension of thrombophlebitis < 5 cm; thrombophlebitis of the great saphenous vein and bedridden patients.
- Heparin analogs (fondaparinux)Indications: Prophylaxis for major orthopedic surgery; extension of thrombophlebitis length ≥ 5 cm in truncal veins or major side branches (provided the thrombus is further than 3 cm from the saphenofemoral (SF) crosse)Note: In case of thrombosis risk factors or extended thrombus, semi-therapeutic or therapeutic anticoagulation if necessary!
- Therapy of superficial venous thrombosis (OVT) and distance to the deep venous system (crosse) < 3 cm: Therapeutic anticoagulation as in deep vein thrombosis (DVT) for 4 weeks to 3 months (see under “Thrombosis”).
- See also under “Further therapy”.
