2 Definition Definition Causes Causes Risk Factors Risk Factors
Symptoms Symptoms Importance Importance Treatments Treatments
Content Introduction Aims Methods Results Conclusions Collecting
Articles Collecting Articles Research Question Research Question
Query Query Inclusion / Exclusion criteria Inclusion / Exclusion
criteria Data to extract from the articles Data to extract from the
articles Variables for data extraction Variables for data
extraction Study type Study type Follow-up Follow-up Participants
Participants Treatments applied Treatments applied
Slide 3
Superficial Venous Thrombosis of the Lower Limbs Superficial
venous thrombosis consists in the formation of a blood clot in a
superficial vein. Most commonly, it affects the lower limbs. Under
normal physiological conditions, there is a continuous formation of
clots in the veins, but they disintegrate rapidly, not causing any
harm. Definition Methods Aims Introduction Results Conclusions
3
Slide 4
Superficial Venous Thrombosis of the Lower Limbs Varicose
veins; Hormone therapy; Family history; History of malignancy; Risk
Factors Uncu H., 2009 Cigarette smoking; Obesity; Diabetes Methods
Aims Introduction Results Conclusions 4
Slide 5
Superficial Venous Thrombosis of the Lower Limbs Causes Methods
Aims Introduction Results Conclusions 5
Slide 6
Symptoms Superficial Venous Thrombosis of the Lower Limbs Pain
Redness of the skin with increase of temperature Induration Edema
(swelling) Fever Methods Aims Introduction Results Conclusions
6
Slide 7
SVT Saphenofemoral junction Perforator veins Saphenopopliteal
junction DVT (deep venous thrombosis) The thrombus can detach and
clot the pulmonary artery Pulmonary Embolism Importance The
thrombus can reach the deep venous system through: Methods Aims
Introduction Results Conclusions 7
Slide 8
Superficial venous thrombosis rarely causes serious
complications,BUT In some cases, SVT can evolve (Litzendorf and
Satiani, 2011): 6-40% - Deep Venous Thrombosis (DVT); 2-13% -
Pulmonary embolism. Superficial Venous Thrombosis of the Lower
Limbs Importance - statistics Methods Aims Introduction Results
Conclusions 8
Slide 9
Treatment temporal evolution Elastic compression bandages and
anti-inflammatory creams Surgery (patients with serious pain)
Medical therapy Drugs* Superficial Venous Thrombosis of the Lower
Limbs (Decousus H, Epinat M, Guillot K, 2003) Methods Aims
Introduction Results Conclusions * There is still no consensus
about using surgery as a possible treatment. Therefore, in some
cases, it is still used. 9
Slide 10
Superficial Venous Thrombosis of the Lower Limbs Treatments
Possible Treatments Symptomatic control Surgery (cut of the
saphenofemoral junction) Drugs: - Warfarin; - Low Molecular Weight
Heparin; - Nonsteroidal Anti-inflammatory Agent; - Xabans (Direct
Xa factor inhibitor); - Fondaparinux (indirect Xa factor inhibitor)
If SVT has a history longer than one week, medical therapy is
considered to be more effective than surgical therapy (Bergqvist D,
Brunkwell J, Jensen N, Persson NH 1990) Methods Aims Introduction
Results Conclusions 10
Slide 11
Costs Compressions alone had the lowest costs Medical costs
Treatments including LMWH had the highest costs Medical costs Lost
of working days and/or inactivity was higher in the subjects
treated only with stockings Social costs (Belcaro G. et al, 1999)
Superficial Venous Thrombosis of the Lower Limbs Methods Aims
Introduction Results Conclusions 11
Slide 12
Superficial Venous Thrombosis of the Lower Limbs Aims Methods
Aims IntroductionResults Conclusions Discovering the possible
treatments Evaluate their results and complications 12
Slide 13
Databases used: Pubmed Scopus ISI Web of Knowledge Superficial
Venous Thrombosis of the Lower Limbs Collecting Articles Methods
AimsIntroductionResults Conclusions 13
Slide 14
Superficial Venous Thrombosis of the Lower Limbs Research
Question: Which are the results and complications of Superficial
Venous Thrombosis treatments? Superficial Venous Thrombosis of the
Lower Limbs Methods AimsIntroductionResults Conclusions 14
Slide 15
SVT of the Lower Limbs Results/ complications Treatment Our aim
Aim to achieve with the queries Superficial Venous Thrombosis of
the Lower Limbs Methods AimsIntroductionResults Conclusions 15
Slide 16
Venous Thrombosis Entry Terms Thrombosis, Venous; Thromboses,
Venous; Venous Thromboses; Phlebothrombosis; Phlebothromboses; Deep
Vein Thrombosis; Deep Vein Thromboses; Thromboses, Deep Vein; Vein
Thromboses, Deep Venous Thrombosis, Deep; Deep-Vein Thrombosis;
Deep-Vein Thromboses; Thromboses, Deep-Vein; Thrombosis, Deep-Vein;
Vein Thrombosis, Deep; Thrombosis, Deep Vein; Deep-Venous
Thrombosis Deep-Venous Thromboses; Thromboses, Deep-Venous;
Thrombosis, Deep-Venous; Deep Venous Thrombosis; Deep Venous
Thromboses; Thromboses, Deep Venous; Thrombosis, Deep Venous;
Venous Thromboses, Deep Query - Pubmed Methods
AimsIntroductionResults Conclusions 16
Query - Pubmed Pubmed Query - Main Topics Condition definition:
(superficial venous thrombosis OR SVT) AND (lower extremity OR leg
OR lower limb) Intervention: (Treatments OR therapeutics OR
therapy) Analysis of: (results OR complications) Superficial Venous
Thrombosis of the Lower Limbs Query applied on Pubmed (superficial
venous thrombosis OR SVT) AND (lower extremity OR leg OR lower
limb) AND (Treatments OR therapeutics OR therapy) AND (results OR
complications) Methods AimsIntroductionResults Conclusions 18
Slide 19
Scopus Query - Main Topics Condition definition: (svt OR
superficial venous thrombosis) AND (lower limbs OR lower extremity
OR legs) Intervention: (Treatments or therapy or therapeutics)
Analysis of: (results OR complications) Query - Scopus Superficial
Venous Thrombosis of the Lower Limbs Query applied on Scopus
TITLE-ABS-KEY (svt OR superficial venous thrombosis) AND (lower
limbs OR lower extremity OR legs)) AND (Treatments or therapy or
therapeutics) AND (results OR complications) AND DOCTYPE(ar)
Methods AimsIntroductionResults Conclusions 19
Slide 20
Definition of the topic TOPICS (superficial venous thrombosis
OR svt) (treatment OR therapy OR therapeutics ) (lower limb) NOT
(varicose) NOT (artery) NOT (ulcers) Definition of the target group
and thematic scope REFINED BY Languages=(ENGLISH) Document
Type=(ARTICLE) Query - ISI Web of Knowledge Methods
AimsIntroductionResults Conclusions 20
Slide 21
Query - ISI Web of Knowledge Superficial Venous Thrombosis of
the Lower Limbs Query obtained and applied on ISI Web of Knowledge
Topic=(superficial venous thrombosis OR svt) AND Topic=(treatment
OR therapy OR therapeutics) AND Topic=(lower limb) NOT
Topic=(varicose) NOT Topic=(artery) NOT Topic=(ulcers) Refined by:
Languages=(ENGLISH) AND Document Type=(ARTICLE) Timespan=1980-2011
Methods AimsIntroductionResults Conclusions 21
Slide 22
Outcome Articles obtained: Superficial Venous Thrombosis of the
Lower Limbs Deadline for the research of the articles: March 22,
2012 Methods AimsIntroductionResults Conclusions 22
First selection phase Methods AimsIntroductionResults
Conclusions 24
Slide 25
Inclusionand exclusion criteria Inclusion and exclusion
criteria Studies that fully describe the treatment applied in SVT;
Studies describing the evolution of SVT according to the treatment
applied. Articles without original data (ex: systematic review);
Articles not written in English, Portuguese or Spanish; Articles
whose full-text was not available. Articles describing only one
clinical case. Inclusion CriteriaExclusion Criteria Methods
AimsIntroductionResults Conclusions 25
Slide 26
By reading the abstracts a first selection of the articles was
made. - Language - Study Type - Not relevant - Language - Study
Type - Not relevant First selection phase Methods
AimsIntroductionResults Conclusions 26
Second selection phase Methods AimsIntroductionResults
Conclusions 28
Slide 29
Second selection phase 1 Articles in doubt, during the first
selection phase, due to their ambiguous abstracts. - Not available
- Not relevant 1 - Repeated - Not available - Not relevant 1 -
Repeated Methods AimsIntroductionResults Conclusions 29
Slide 30
Order of exclusion - summary Language Type of Study Relevance
Availability 13% of the articles excluded 5% of the articles
excluded 73% of the articles excluded 6% of the articles excluded
Superficial Venous Thrombosis of the Lower Limbs For a total of 361
articles obtained Methods AimsIntroductionResults Conclusions
30
Slide 31
1 High vs. low doses of low-molecular-weight heparin for the
treatment of superficial vein thrombosis of the legs: a
double-blind, randomized trial 2 Superficial Thrombophlebitis ofthe
Legs: A Randomized, Controlled, Follow-up Study 3 Simultaneous
occurrence of superficial and deep thrombophlebitis in the lower
extremity 4 High versus low doses of unfractionated heparin for the
treatment of superficial thrombophlebitis of the leg. A
prospective, controlled, randomized study 5 A comparison of
low-molecular-weight heparin and combined therapy of
low-molecular-weight heparin with an anti-inflammatory agent in the
treatment of superficial vein thrombosis List of the articles
Methods AimsIntroductionResults Conclusions 31
Slide 32
6 The use of liposomal heparin spray-gel in the treatment of
superficial thrombophlebitis: a multicenter clinical investigation
analysis; 7 A Pilot Randomized Double-blind Comparison of a
Low-Molecular-Weight Heparin, a Nonsteroidal Anti-inflammatory
Agent, and Placebo in the Treatment of Superficial Vein Thrombosis;
8 Prospective five-year study of ultrasound-guided foam
sclerotherapy in the treatment of great saphenous vein reflux; 9
Fondaparinux for the Treatment of Superficial-Vein Thrombosis in
the Legs; 10 A retrospective analysis of patients treated for
superficial vein thrombosis; 11 Fondaparinux for Isolated
Superficial Vein Thrombosis of the Legs : A Cost-Effectiveness
Analysis; List of the articles Methods AimsIntroductionResults
Conclusions 32
Slide 33
Methods AimsIntroductionResults Conclusions 33
Slide 34
General table of the articles data Article nFollow-up (in days)
N of participantsTreatments 1 90164LMWH* 2 6562Surgery, LMWH*,
elastic compression 3 182542Heparin; Warfarin; surgery 4 18360LMWH*
5 1050LMWH* 6 1488Lipossomal gel-spray heparin 7 97427Heparin;
placebo; tenoxicam 8 1825146Ultra-sound guided foam sclerotherapy 9
773002Fondaparinux; Placebo 10 182573LMWH*; vitamin k antagonists;
nasodroparin 11 4510000Fondaprinux; Placebo * LMWH: Low Molecular
Weight Heparin 34 Methods AimsIntroductionResults Conclusions
Slide 35
Variables for data extraction Superficial Venous Thrombosis of
the Lower Limbs Methods AimsIntroductionResults Conclusions 35
Slide 36
Relative to the article extraction: Database Article number
Year Study Type Variables Methods AimsIntroductionResults
Conclusions Relative to articles content: N of participants N of
groups Follow-up Drop out Age Gender Treatments Efficacy
Superficial Venous Thrombosis of the Lower Limbs 36
Slide 37
Data extraction to SPSS Superficial Venous Thrombosis of the
Lower Limbs Methods AimsIntroductionResults Conclusions 37
Slide 38
Study Type Methods AimsIntroduction Results Conclusions
Superficial Venous Thrombosis of the Lower Limbs 38
Slide 39
Follow-up (in days) Superficial Venous Thrombosis of the Lower
Limbs Article n Methods AimsIntroduction Results Conclusions
39
Slide 40
Participants Superficial Venous Thrombosis of the Lower Limbs
Article n Total of participants: 14 488 Methods AimsIntroduction
Results Conclusions 40
Slide 41
Different treatments applied Eleven articles analyzed: a total
of 14 488 patients received treatment, 1502 with placebo and 11500
with Fondaparinux. The remaining treatments used are in the chart
below. Methods AimsIntroduction Results Conclusions 41
Slide 42
Heparin Data Superficial Venous Thrombosis of the Lower Limbs
Methods AimsIntroduction Results Conclusions 42
Slide 43
Antithrombotic therapy vs placebo (1/2) Superficial Venous
Thrombosis of the Lower Limbs Methods AimsIntroduction Results
Conclusions Incidence of DVT by day 12 Placebo 4/111 - (3.6%) 40-mg
enoxaparin* 1/109 - (0.9%) 1.5 mg/kg enoxaparin* 1/102 - (1.0%)
Incidence of DVT and SVT by day 12 Placebo 34/111 - (30.6%) 40-mg
enoxaparin* 9/109 - (8.3%) 1.5 mg/kg enoxaparin* 7/102 - (6.9%)
Data obtained from article 7 * enoxaparin: a kind of heparin (in
this case, different doses were used) 43
Slide 44
Antithrombotic therapy vs placebo (2/2) Methods
AimsIntroduction Results Conclusions Incidence of pulmonary
embolism or DVT Placebo 20/1500 - (1.3%) Fondaparinux 3/1502 -
(0.2%) Incidence of delayed surgery by day 77 Placebo 52/1500 -
(3.5%) Fondaparinux 8/1502 - (0.5%) Superficial Venous Thrombosis
of the Lower Limbs Data obtained from article 9 44
Slide 45
Methods AimsIntroduction Results Conclusions Elastic
compression vs anti-coagulants and surgery (1/2) Superficial Venous
Thrombosis of the Lower Limbs Elastic compression only Thrombus
extension at 3 months 32/78 - (41.0%) DVT at 3 months 6/78 - (7.7%)
Thrombus extension at 6 months 13/78 - (16.7%) Total for
complications 51/78 - (65.4%) Elastic compression + LMWH + Delayed
surgery Thrombus extension at 3 months 4/76 - (5.3%) DVT at 3
months 0/76 - (0.0%) Thrombus extension at 6 months 1/76 - (1.3%)
Total for complications 5/76 - (6.6%) Data obtained from article 2
45
Slide 46
Methods AimsIntroduction Results Conclusions Superficial Venous
Thrombosis of the Lower Limbs Elastic compression + oral
anti-coagulant Thrombus extension at 3 months 5/71 - (7.0%) DVT at
3 months 0/71 - (0.0%) Thrombus extension at 6 months 5/71 - (7.0%)
Total for complications 10/71 - (14.0%) Elastic compression vs
anti-coagulants and surgery (2/2) Data obtained from article 2
46
Slide 47
High vs low doses of LMWH Superficial Venous Thrombosis of the
Lower Limbs Incidence of thromboembolic complications High dosesLow
doses During treatment period 0/30 - (0%)4/30 - (13.3%) After drug
discontinuation 1/30 - (3.3%)2/30 - (6.7%) Incidence of thrombus
extension High dosesLow doses During treatment period 3/30 -
(10.0%)7/30 - (23.3%) After drug discontinuation 0/30 - (0%)
Methods AimsIntroduction Results Conclusions Data obtained from
article 4 47
Slide 48
Prophylactic vs therapeutic doses of LMWH Methods
AimsIntroduction Results Conclusions Prophylatic doses N of
patients with complications During treatment period5/81 - (6.2%)
After drug discontinuation2/81 - (2.5%) Therapeutic doses N of
patients with complications During treatment period2/83 - (2.4%)
After drug discontinuation4/83 - (4.8%) Superficial Venous
Thrombosis of the Lower Limbs Data obtained from article 1 48
Slide 49
49 Lipohep spray-gel is an heparin gel that has recently
appeared on the market. Its effect has been compared with
subcutaneous injections of heparin (as showed above).
Lipossomalgel-spray heparin vs heparin injections Lipossomal
gel-spray heparin vs heparin injections Methods AimsIntroduction
Results Conclusions Data obtained from article 6 N Lipohep: 43 N
injections: 45
Slide 50
High doses of LMWH have better results than low doses.
Conclusions (1/3) 50 Antithrombotic therapy is more effective than
placebo and may avoid surgery; Elastic compression by itself seems
not to be a good option of treatment. Although the group involving
delayed surgery as treatment had better outcomes, anti-coagulants
seem to be a good alternative to it; Methods AimsIntroduction
Results Conclusions
Slide 51
51 There are no statistically significant differences between
prophylactic and therapeutic doses of LMWH, after drug
discontinuation. Methods AimsIntroduction Results Conclusions
Conclusions (2/3) There are no statistically significant
differences between the spray-gel and the injections, so as it
represents an easier way of treatment Lipohep spray gel seems to be
an alternative to be considered.
Slide 52
52 It also important to mention ultrasound-guided foam
sclerotherapy (UGFS), a recent treatment in which study (article 8)
no serious adverse outcomes were observed and it had 100% patient
acceptance of success. However, as it is a recent finding, more
studies need to be done in order to evaluate its effect in treating
SVT. Unfortunately, we did not found any articles comparing
fondaparinux and heparin, therefore we were not able to conclude
which one was the best. Even so, there seems to exist a preference
regarding heparin. AimsIntroductionResults Conclusions Methods
Conclusions (3/3)
Slide 53
Heterogeneity of the articles included: each article presented
unique points of view and different methodology; Unavailability of
articles in the UP database (23 articles): we can't assure the
inexistence of important information among those whose full-text
wasnt available; Articles describing very specific populations:
clinical cases or articles describing SVT within very specific
populations (cancer patients, etc.) were excluded. Study
Limitations Superficial Venous Thrombosis of the Lower Limbs
AimsIntroductionResults Conclusions Methods 53