Di Nisio Marcello, Camporese Giuseppe, Di Micco Pierpaolo, Martini Romeo, Ageno Walter, Prandoni Paolo
Department of Medicine and Ageing Sciences, "G D'Annunzio" University, 66013 Chieti, Italy.
Clinica Medica 1, Department of Medicine, DIMED, Padua University Hospital, 35128 Padua, Italy.
Healthcare (Basel). 2024 Jul 31;12(15):1517. doi: 10.3390/healthcare12151517.
Once considered relatively benign, superficial vein thrombosis (SVT) of the lower limbs is linked to deep vein thrombosis (DVT) or pulmonary embolism (PE) in up to one fourth of cases. Treatment goals include alleviating local symptoms and preventing SVT from recurring or extending into DVT or PE. Fondaparinux 2.5 mg once daily for 45 days is the treatment of choice for most patients with SVT. Potential alternatives include intermediate-dose low-molecular-weight heparin or the direct oral factor Xa inhibitor rivaroxaban, however, these require further evidence. Despite these treatment options, significant gaps remain, including the role of systemic or topical anti-inflammatory agents alone or combined with anticoagulants, and the optimal duration of anticoagulation for patients at varying risk levels. Additionally, the efficacy and safety of factor Xa inhibitors other than rivaroxaban, management of upper extremity SVT, and optimal treatment for SVT near the sapheno-femoral or sapheno-popliteal junctions are not well understood. This narrative review aims to summarize current evidence on anticoagulant treatment for SVT, highlight key unmet needs in current approaches, and discuss how ongoing studies may address these gaps.
下肢浅静脉血栓形成（SVT）曾被认为相对良性，但在多达四分之一的病例中与深静脉血栓形成（DVT）或肺栓塞（PE）有关。治疗目标包括缓解局部症状，防止SVT复发或扩展为DVT或PE。对于大多数SVT患者，首选治疗方法是每日一次皮下注射磺达肝癸钠2.5mg，持续45天。其他可能的替代药物包括中剂量低分子肝素或直接口服因子Xa抑制剂利伐沙班，然而，这些药物还需要更多证据支持。尽管有这些治疗选择，但仍存在重大差距，包括单独使用或与抗凝剂联合使用的全身或局部抗炎药的作用，以及不同风险水平患者的最佳抗凝持续时间。此外，除利伐沙班之外的因子Xa抑制剂的疗效和安全性、上肢SVT的管理以及大隐静脉-股静脉或大隐静脉-腘静脉交界处附近SVT的最佳治疗方法尚不清楚。本叙述性综述旨在总结目前关于SVT抗凝治疗的证据，强调当前方法中尚未满足的关键需求，并讨论正在进行的研究如何填补这些空白。
