Management of thrombophlebitis: are the new anticoagulant drugs useful?
From time to time, I have to manage patients with thrombophlebitis. The most effective drug for this has been Fondaparinux (a synthetic low molecular weight heparin) which moderates symptoms if given daily for about 6 weeks. Alternatively, low molecular weight heparins may be used for the same duration. This strategy is supported by ACCP Guidelines and by a Cochrane review.
The problem is that these drugs can only be given by daily injections. Many patients are a little reluctant to agree to this regime. In the last decade, several of the newer oral anticoagulant drugs have been licensed for the prevention and treatment of venous thrombo-embolism. I have recommended these to my patients for some time in order to prevent DVT after varicose veins treatments in high risk patients. Published guidelines have not recommended any of this group of drugs for the treatment of thrombophlebitis since no clinical trial had been done.
A recently published paper in the Lancet addresses this issue in a randomised clinical trial. Fondaparinux and rivaroxaban were compared in a study which concluded that they were equally effective. The oral anticoagulant drug is less expensive than Fondaparinux or heparin injection and more acceptable to patients. Oral rivaroxaban looks as though it will be the definitive treatment for thrombophlebitis in the future.
Philip Coleridge Smith, Consultant Vascular Surgeon