superficial vein thrombosis

Superficial yet Significant

Thrombosis of superficial veins (e.g., Saphenous, Cephalic, Basilic). Key risk: Extension into deep system (DVT) via saphenofemoral (SFJ) or saphenopopliteal (SPJ) junctions.

diagnosis

• Clinical: Palpable cord, erythema, tenderness along vein course.
• Ultrasound: Mandatory to define:
  1. Length of clot.
  2. Distance to deep vein junction (SFJ/SPJ).

management algorithm (non-catheter)

Stratify by risk of extension to deep system.

Risk	Criteria	Management
High	Clot $\le$ 3 cm from SFJ/SPJ.	Full Dose Anticoagulation (Treat as Deep Vein Thrombosis). Duration: 3 months.
Intermediate	Clot > 3 cm from SFJ/SPJ AND $\ge$ 5 cm long.	Prophylactic Dose x 45 days. • Rivaroxaban 10 mg PO daily • Fondaparinux 2.5 mg SC daily • LMWH (prophylactic/intermediate dose)
Low	Clot > 3 cm from SFJ/SPJ AND < 5 cm long.	Supportive (NSAIDs, Heat). Serial US if symptoms worsen.

exceptions (treat as intermediate/high)

Even if “Low Risk” by size, consider prophylactic anticoagulation (45 days) if:

• Pregnancy
• Active cancer
• Prior VTE history
• Recent surgery/trauma

catheter-associated svt

• Context: Thrombus in superficial vein (e.g., Cephalic, Basilic) secondary to IV cannulation.
• Management:
  1. Remove IV.
  2. Supportive care (Topical NSAIDs, warm compresses).
  3. NO anticoagulation required (unless extending into deep system).

evidence

• SURPRISE Trial (2017):
  • Comparison: Rivaroxaban 10 mg OD vs. Fondaparinux 2.5 mg SC OD for SVT at risk of DVT.
  • Result: Rivaroxaban non-inferior for efficacy; similar bleeding rates.
  • Impact: Validates oral option (Rivaroxaban) over injections for SVT.

related pages: Deep Vein Thrombosis, Anticoagulants