St. Emlyn´s - October 13, 2017 - By Dan Horner
"Been a while since we have had any clotology on here. That is unacceptable. So here we go with another journal club fest on the management of acute VTE.
Now we have improved access to whole leg compression ultrasound, some reliable safety data around the use of this technology and a specialist society for vascular sonographers it is not surprising that we are picking up more and more small clots in an ED setting. Here in both east and west Virchester, we can add to this number an increased rate of confirmed superficial vein thrombosis (SVT), or thrombophlebitis by its old name. Not a bad thing really, when you consider that unprovoked thrombophlebitis can herald fairly nasty thromboembolic disease, or sometimes even malignancy. These clots often extend far more proximal than their symptomatic margin, and sonographic confirmation and characterisation can be useful to guide treatment decisions.
There is evidence (from the STENOX 1 and CALISTO 2 trials) to suggest that treatment of these clots can lead to a reasonable reduction in serious event rates. An alumnus of virchester has also recently looked at the management of superficial vein thrombosis for her FRCEM clinical topic review. Pretty convincing data to treat these patients with prophylactic dose anticoagulation really. This evidence is supported by BMJ best practice and ACCP guidelines, that offer risk stratification criteria so you can perhaps select out those likely to result in higher risk and concentrate on advising those patients carefully regarding treatment options. However, the current evidence base is for fondaparinux treatment and 6 weeks of injections can be a real (and literal) pain. If patients are reluctant to self inject, then it also can come at considerable cost and nursing resource. One wonders if there is another way…."