Treatment for superficial thrombophlebitis of the leg (Review) Di Nisio M, Wichers IM, Middeldorp S This is a reprint of a Cochrane review, prepared and maintained by The Cochrane Collaboration and published in The Cochrane Library 2012, Issue 3 http://www.thecochranelibrary.com Treatment for superficial thrombophlebitis of the leg (Review) Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. TABLE OF CONTENTS HEADER....................................... 1 ABSTRACT ...................................... 1 PLAINLANGUAGESUMMARY . 2 BACKGROUND .................................... 2 OBJECTIVES ..................................... 3 METHODS ...................................... 3 RESULTS....................................... 5 Figure1. ..................................... 7 Figure2. ..................................... 8 DISCUSSION ..................................... 11 AUTHORS’CONCLUSIONS . 12 ACKNOWLEDGEMENTS . 12 REFERENCES ..................................... 12 CHARACTERISTICSOFSTUDIES . 17 DATAANDANALYSES. 42 Analysis 1.1. Comparison 1 Fondaparinux versus placebo, Outcome 1 Pulmonary embolism. 51 Analysis 1.2. Comparison 1 Fondaparinux versus placebo, Outcome 2 Deep vein thrombosis. 51 Analysis 1.3. Comparison 1 Fondaparinux versus placebo, Outcome 3 Deep vein thrombosis and pulmonary embolism. 52 Analysis 1.4. Comparison 1 Fondaparinux versus placebo, Outcome 4 Extension of ST. 52 Analysis 1.5. Comparison 1 Fondaparinux versus placebo, Outcome 5 Recurrence of ST. 53 Analysis 1.6. Comparison 1 Fondaparinux versus placebo, Outcome 6 Mortality. 53 Analysis 1.7. Comparison 1 Fondaparinux versus placebo, Outcome 7 Major bleeding. 54 Analysis 1.8. Comparison 1 Fondaparinux versus placebo, Outcome 8 Clinically relevant non-major bleeding. 54 Analysis 1.9. Comparison 1 Fondaparinux versus placebo, Outcome 9 Minor bleeding. 55 Analysis 1.10. Comparison 1 Fondaparinux versus placebo, Outcome 10 Arterial thromboembolic complication. 55 Analysis 1.11. Comparison 1 Fondaparinux versus placebo, Outcome 11 Any adverse event. 56 Analysis 1.12. Comparison 1 Fondaparinux versus placebo, Outcome 12 Non-fatal serious adverse event. 56 Analysis 2.1. Comparison 2 Prophylactic LMWH versus placebo, Outcome 1 Venous thromboembolism end-of- treatment.................................... 57 Analysis 2.2. Comparison 2 Prophylactic LMWH versus placebo, Outcome 2 Venous thromboembolism 3-month follow up. ..................................... 57 Analysis 2.3. Comparison 2 Prophylactic LMWH versus placebo, Outcome 3 Extension and/or recurrence of ST. 58 Analysis 2.4. Comparison 2 Prophylactic LMWH versus placebo, Outcome 4 Major bleeding. 58 Analysis 2.5. Comparison 2 Prophylactic LMWH versus placebo, Outcome 5 Heparin-induced thrombocytopenia. 59 Analysis 3.1. Comparison 3 Therapeutic LMWH versus placebo, Outcome 1 Venous thromboembolism end-of- treatment.................................... 59 Analysis 3.2. Comparison 3 Therapeutic LMWH versus placebo, Outcome 2 Venous thromboembolism 3-month follow up. ..................................... 60 Analysis 3.3. Comparison 3 Therapeutic LMWH versus placebo, Outcome 3 Extension and/or recurrence of ST. 60 Analysis 3.4. Comparison 3 Therapeutic LMWH versus placebo, Outcome 4 Major bleeding. 61 Analysis 3.5. Comparison 3 Therapeutic LMWH versus placebo, Outcome 5 Heparin-induced thrombocytopenia. 61 Analysis 4.1. Comparison 4 Prophylactic LMWH + elastic compression stockings (ECS) versus elastic stockings alone, Outcome 1 Venous thromboembolism. 62 Analysis 4.2. Comparison 4 Prophylactic LMWH + elastic compression stockings (ECS) versus elastic stockings alone, Outcome 2 Extension and/or recurrence of ST. ...... 62 Analysis 5.1. Comparison 5 LMWH versus heparin spray gel, Outcome 1 Deep-venous thrombosis. 63 Analysis 5.2. Comparison 5 LMWH versus heparin spray gel, Outcome 2 Patients with thrombus at 21 days. 63 Analysis 5.3. Comparison 5 LMWH versus heparin spray gel, Outcome 3 Allergic reaction or elevated sedimentation rate...................................... 64 Analysis 6.1. Comparison 6 Therapeutic LMWH versus saphenofemoral disconnection, Outcome 1 Venous thromboembolism.. 64 Treatment for superficial thrombophlebitis of the leg (Review) i Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 6.2. Comparison 6 Therapeutic LMWH versus saphenofemoral disconnection, Outcome 2 Extension and/or recurrenceofST.................................. 65 Analysis 6.3. Comparison 6 Therapeutic LMWH versus saphenofemoral disconnection, Outcome 3 Major bleeding. 65 Analysis 6.4. Comparison 6 Therapeutic LMWH versus saphenofemoral disconnection, Outcome 4 Complications. 66 Analysis 7.1. Comparison 7 Fixed-dose LMWH versus NSAIDs, Outcome 1 Venous thromboembolism. 66 Analysis 7.2. Comparison 7 Fixed-dose LMWH versus NSAIDs, Outcome 2 Extension and/or treatment of ST. 67 Analysis 7.3. Comparison 7 Fixed-dose LMWH versus NSAIDs, Outcome 3 Major bleeding. 67 Analysis 7.4. Comparison 7 Fixed-dose LMWH versus NSAIDs, Outcome 4 Heparin-induced thrombocytopenia. 68 Analysis 8.1. Comparison 8 Weight-adjusted LMWH versus NSAIDs, Outcome 1 Venous thromboembolism. 68 Analysis 8.2. Comparison 8 Weight-adjusted LMWH versus NSAIDs, Outcome 2 Extension and/or recurrence of ST. 69 Analysis 8.3. Comparison 8 Weight-adjusted LMWH versus NSAIDs, Outcome 3 Major bleeding. 69 Analysis 8.4. Comparison 8 Weight-adjusted LMWH versus NSAIDs, Outcome 4 Heparin-induced thrombocytopenia. 70 Analysis 9.1. Comparison 9 Prophylactic LMWH versus NSAIDs, Outcome 1 Venous thromboembolism end-of- treatment.................................... 70 Analysis 9.2. Comparison 9 Prophylactic LMWH versus NSAIDs, Outcome 2 Venous thromboembolism 3-month follow up. ..................................... 71 Analysis 9.3. Comparison 9 Prophylactic LMWH versus NSAIDs, Outcome 3 Major bleeding. 71 Analysis 9.4. Comparison 9 Prophylactic LMWH versus NSAIDs, Outcome 4 Heparin-induced thrombocytopenia. 72 Analysis 10.1. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 1 Pulmonary embolism. 72 Analysis 10.2. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 2 Deep vein thrombosis. 73 Analysis 10.3. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 3 Extension of ST. 73 Analysis 10.4. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 4 Pain reduction. 74 Analysis 10.5. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 5 Hyperaemia reduction. 74 Analysis 10.6. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 6 Tenderness reduction. 75 Analysis 10.7. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 7 Palpable cord reduction. 75 Analysis 10.8. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 8 Mortality. 76 Analysis 10.9. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 9 Major bleeding. 76 Analysis 10.10. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 10 Minor bleeding. 77 Analysis 10.11. Comparison 10 LMWH versus LMWH + acemetacin, Outcome 11 Adverse event. 77 Analysis 11.1. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 1 ST or venous thromboembolism.. 78 Analysis 11.2. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 2 Venous thromboembolism.. 78 Analysis 11.3. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 3 Superficial thrombophlebitis. 79 Analysis 11.4. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 4 Swelling disappearance. 79 Analysis 11.5. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 5 Tenderness disappearance. 80 Analysis 11.6. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 6 Pain disappearance. 80 Analysis 11.7. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 7 Pitting oedema disappearance. ................................. 81 Analysis 11.8. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 8 Collateral veins disappearance. ................................. 81 Analysis 11.9. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 9 Redness disappearance. 82 Analysis 11.10. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 10 Palpable cord disappearance. ................................. 82 Analysis 11.11. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 11 Major bleeding. 83 Analysis 11.12. Comparison 11 Fixed-dose LMWH versus weight-adjusted LMWH, Outcome 12 Heparin-induced thrombocytopenia. 83 Analysis 12.1. Comparison 12 Prophylactic UFH + elastic compression stockings versus elastic compression stockings alone, Outcome 1 Venous thromboembolism. ....... 84 Analysis 12.2. Comparison 12 Prophylactic UFH + elastic compression stockings versus elastic compression stockings alone, Outcome 2 Extension and/or recurrence of ST. .......... 84 Analysis 13.1. Comparison 13 High-dose UFH versus low-dose UFH, Outcome 1 Incidence of venous thromboembolism. 85 Treatment for superficial thrombophlebitis of the leg (Review) ii Copyright © 2012 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Analysis 13.2. Comparison 13 High-dose UFH versus low-dose UFH, Outcome 2 ST recurrence or extension. 85 Analysis 13.3. Comparison 13 High-dose UFH versus low-dose UFH, Outcome 3 Major bleeding. 86 Analysis 13.4. Comparison 13 High-dose UFH versus low-dose UFH, Outcome 4 Heparin-induced thrombocytopenia. 86 Analysis 14.1. Comparison 14 Calcium heparin + elastic compression bandage versus elastic compression bandage alone, Outcome 1 Deep venous thrombosis. 87 Analysis 15.1.