Management of Superficial Venous Thrombosis

Indications for Anticoagulation

Superficial venous thrombosis (SVT) requires anticoagulation when it is in close proximity to the deep venous system (within 3 cm), extends above the knee, or is greater than 5 cm in length, as recommended by the National Comprehensive Cancer Network 1, 2
The American College of Chest Physicians recommends that SVT within 3 cm of the saphenofemoral junction requires therapeutic dose anticoagulation for at least 3 months 1, 2
SVT greater than 5 cm in length requires prophylactic dose anticoagulation for at least 6 weeks, according to the Mayo Clinic Proceedings 1, 3
SVT extending above the knee (involving the great or small saphenous veins) requires prophylactic dose anticoagulation for at least 6 weeks, as stated by the National Comprehensive Cancer Network and the Mayo Clinic Proceedings 1, 4
SVT showing progression on follow-up ultrasound should be treated with prophylactic dose anticoagulation, as recommended by the National Comprehensive Cancer Network 1

Fondaparinux 2.5 mg subcutaneously daily for 45 days is a prophylactic dose option for SVT, as recommended by the American College of Chest Physicians 2
Rivaroxaban 10 mg orally daily for 45 days is a prophylactic dose option for SVT, according to the American College of Chest Physicians 2
Therapeutic dose anticoagulation protocols for VTE should be followed when treating SVT in close proximity to deep veins, as recommended by the National Comprehensive Cancer Network and the American College of Chest Physicians 1, 2

For SVT less than 5 cm in length or below the knee, repeat ultrasound in 7-10 days to assess for progression, as recommended by the National Comprehensive Cancer Network 1
If progression is noted on follow-up imaging, initiate prophylactic dose anticoagulation, according to the National Comprehensive Cancer Network 1

Cancer patients with SVT may benefit from prophylactic dose anticoagulation even for smaller thrombi due to their higher risk of progression, as stated by the National Comprehensive Cancer Network 1
Therapeutic dosing may be used at the clinician's discretion in cancer patients, according to the National Comprehensive Cancer Network 1
Symptomatic treatment for SVT not requiring anticoagulation includes warm compresses, NSAIDs, and elevation, as recommended by the National Comprehensive Cancer Network 1

Inadequate follow-up can miss progression to more serious thrombosis, as noted by the National Comprehensive Cancer Network 1
Inappropriate anticoagulation duration may lead to recurrence, according to the American College of Chest Physicians 2