Treatment of Small Saphenous Vein Thrombosis

Initial Treatment

For patients with Small Saphenous Vein (SSV) thrombosis ≥5 cm in length or extending above the knee, the National Comprehensive Cancer Network recommends initiating prophylactic-dose anticoagulation with fondaparinux 2.5 mg subcutaneously once daily or rivaroxaban 10 mg orally once daily for at least 6 weeks 1, 2
The American College of Radiology suggests that if the catheter is no longer needed, it should be removed, and if the catheter is functioning and venous access is needed, it should be left in place and anticoagulation commenced 5

The National Comprehensive Cancer Network recommends obtaining venous duplex ultrasound to confirm diagnosis, measure exact thrombus length, assess distance from the saphenopopliteal junction, and exclude concomitant deep vein thrombosis (DVT) 1, 3
Laboratory studies, including CBC with platelet count, PT, aPTT, liver and kidney function tests, should be performed 1, 2

For SSV thrombus ≥5 cm or extending above the knee, first-line options include fondaparinux 2.5 mg subcutaneously once daily for 45 days or rivaroxaban 10 mg orally once daily for 45 days 1, 2, 3
The CALISTO trial demonstrated that fondaparinux reduced the composite outcome of DVT/PE, symptomatic extension to the saphenofemoral junction, or symptomatic SVT recurrence by 85% compared to placebo 1
The SURPRISE trial showed rivaroxaban was noninferior to fondaparinux for symptomatic DVT/PE, progression or recurrence of SVT, and all-cause mortality 1, 2

Cancer patients with SSV thrombosis should follow the same anticoagulation recommendations as non-cancer patients 2, 3
The National Comprehensive Cancer Network recommends that cancer patients with SVT have similar risks of death and DVT/PE recurrence as those with DVT 3

Graduated compression stockings (30-40 mm Hg knee-high) should be used in combination with anticoagulation 3
NSAIDs can be used for symptom relief, but should be avoided if platelet count <20,000-50,000/mcL or severe platelet dysfunction 1, 2, 3

Patients should be monitored for extension into the deep venous system, which necessitates immediate escalation to therapeutic anticoagulation 3, 4
Repeat ultrasound is indicated if clinical progression occurs or for initially small thrombi managed conservatively 1, 2, 3