TAKE-HOME MESSAGE Although there is insufficient evidence to support or refute the utility of systemic or topical therapies for superficial thrombophlebitis, the use of nonsteroidal anti-inflammatory drugs, heat, and anticoagulants (for low-risk thromboses) is reasonable. What Is the Most Effective Treatment of Superficial Thrombophlebitis? EBEM Commentators Randolph P. Maddox, MD Rawle A. Seupaul, MD Department of Emergency Medicine University of Arkansas for Medical Sciences Little Rock, AR Results A total of 30 randomized controlled trials (6,462 patients) were included for analysis; however, because none of the trials evaluated similar treat- ment comparisons for the same out- comes, a meta-analysis could not be performed. Aside from 2 random- ized controlled trials, 2,3 most trials were small and of poor quality. The large, industry-sponsored CALISTO trial 2 results supporting the use of fondaparinux have not been replicated. Furthermore, the results are imprecise (as noted by wide confidence intervals around the number needed to treat) and did not include patients with superficial vein thrombosis within 3 cm of the saphenofemoral junction. There were no clinical trials assessing topical therapies included in the systematic review. Commentary Superficial vein thrombophlebitis is a common disorder that was previ- ously perceived to be a relatively benign, self-limiting condition. It is typically a clinical diagnosis charac- terized by pain, erythema, indu- ration, and perivenous swelling producing a cordlike structure usu- ally involving the lower extremities, but may also be diagnosed by ultra- sonography or other forms of lower extremity imaging. Treatment is directed at relieving pain, inflam- mation, and prevention of progres- sion to deep venous thrombosis. 4 Interventions to reduce adverse outcomes from superficial vein thrombosis compared to placebo. N ARR; NNT (95% CI) PE DVT Fondaparinux 2 3,002 0.4%; 250 (143–1,000) 1%; 100 (63–161) Enoxaparin (40 mg) 3 427 Not significant Not significant NSAIDs 3 427 Not significant Not significant ARR, Absolute risk reduction; NNT, number needed to treat; CI, confidence interval; PE, pulmonary embolism; DVT, deep venous thrombosis; NSAIDs, nonsteroidal anti-inflammatory drugs. METHODS DATA SOURCES This is the second update of the original Cochrane systematic review published in 2007. 1 The search for relevant trials included the specialized register of the Cochrane Peripheral Disease group, the Cochrane Central Register of Controlled Trials, reference lists of relevant articles, and conference proceedings of the International Society for Thrombosis and Hemostasis (2003 to 2011) and the American Society of Hematology (2004 to 2011). No language restrictions were used. Content experts in the field were also contacted. STUDY SELECTION Randomized controlled trials including any treatment versus placebo or other interventions to relieve signs and symptoms or to prevent complications of superficial thrombophlebitis were included. The primary efficacy outcome was defined as the development of symptomatic venous thromboembolism (deep venous thrombosis or pulmonary embolism); the primary safety outcome was major bleeding. DATA EXTRACTION AND SYNTHESIS Two authors independently extracted data and assessed PULMONARY/SYSTEMATIC REVIEW SNAPSHOT Volume 67, no. 5 : May 2016 Annals of Emergency Medicine 671
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