How would you manage superficial thrombophlebitis of the great saphenous vein involving the knee and calf?

Would you label this as intermediate or high risk and treat with prophylactic or full dose AC? What duration would you treat for?

1 Answer

Mednet MemberInvited Expert

Hematology · University of Rochester School of Medicine and Dentistry

Answered on

I would point you to an excellent algorithm created by Sherry Scovell on UpToDate, "Superficial Vein Thrombosis and Phlebitis of the Lower Extremity Veins" which has informed my practice.

The highlights of the approach utilized are to perform imaging with Doppler ultrasound to determine the length of the clot and its proximity to the deep venous system. If within 3 cm of the deep venous system, it is treated as a DVT for three months with therapeutic anticoagulation. If it is within 3-5 cm of the saphenofemoral junction (i.e., the deep venous system) or 5 cm or greater in length, it is treated with prophylactic anticoagulation for 45 days. If none of these apply, it can be observed with serial ultrasound and symptomatic assessment.

D-dimer at baseline and also at decision points regarding anticoagulation are utilized.