“Non-standard” superficial venous thrombosis management. Should we consider a tailored approach? A critical review and discussion

Thrombophlebitis is an inflammatory process of the superficial veins with coexistent venous thrombosis, usually occurring in patients with specific preconditions (trauma, surgery or inactivity, signs of venous insufficiency, malignancies). The concept of thrombophlebitis has evolved over time and also the definition has changed from “Thrombophlebitis” to “Superficial venous thrombosis” (SVT). SVT course is usually benign if an appropriate and prompt treatment is undertaken. Pharmacological treatment includes anticoagulation with low molecular weight heparin (LWMH), fondaparinux and, more recently, rivaroxaban. In selected cases the course of thrombophlebitis is not self-limited and the management definitely appears challenging for clinicians and not homogeneous among different Centres. SVT complications include deep venous thrombosis (DVT) and Pulmonary Embolism (PE) and thrombosis recurrence. In this review we define “non standard” SVT those cases presenting with one or more of the following features: SVT involving healthy veins; recurrent, migrant or significantly extended SVT; SVT involving deep vein confluence; SVT not associated to recognized risk factors, especially if occurring in young subjects). In such “non standard” cases, SVT may also represent the epiphenomenon of a more complex systemic condition. Therefore investigation may require more attention and resources. This series of clinical cases focuses on uncertainties in the management of “non standard” SVT, from diagnosis to treatment, and it underlines on the one side the need of a multidisciplinary approach to investigation and care and on the other side the opportunity of a systematic data collection and analysis to provide more reliable recommendations in this setting.