Treatment of thrombophlebitis. Current guidelines and clinical practice: 616.14-002

Abstract

Introduction. In treatment of patients with surface vein thrombosis (SVT) specialists are guided by two regulatory documents — the Order of the Russian Ministry of Health (further — the Order) and the corresponding Clinical Recommendations (further — Recommendations). The content of these two documents does not coincide in some aspects that cause certain difficulties in treatment of this nosology.

Aim: to study the state of real clinical practice in treatment of patients with SVT. 

Materials and methods. An anonymous opinion of 128 specialists in treatment of vein diseases was received. The questionnaire included 10 questions concerning the choice of treatment tactics, use of pharmaceuticals and methods of surgical treatment.

Results. The largest discrepancies between the Recommendations and clinical practice relate to inpatient treatment, anticoagulant therapy and endovenous thermocoagulation application. In spite of detailed elaboration of patient’s treatment with SVT there are enough contradictions in current Recommendations with the Order. This causes increased legal risks during treatment of this category of patients.

Conclusion. Currently there is a request from the professional community for revision of the Order No837n from 09.11.2012 due to appearance of new pharmaceuticals and treatment methods during the period from signing the Order to the present.

REFERENCES

1. CoonW.W.,WillisP.W.,KellerJ.B.Venousthromboembolismand other venous disease in the Tecumseh community health study. Circulation. 1973;48(4):839–46. DOI: 10.1161/01.cir.48.4.839.

2. Marchiori A., Mosena L., Prandoni P. Superficial vein thrombosis: risk factors, diagnosis, and treatment. Semin Thromb Hemost. 2006;32(7):737–43. DOI: 10.1055/s-2006–951459.

3. Decousus H., Epinat M., Guillot K. Superficial vein thrombosis: risk factors, diagnosis, and treatment. Curr Opin Pulm Med. 2003;9(5):393–7. DOI: 10.1097/00063198-200309000-00009.

4. Decousus H., Leizorovicz A. Superficial thrombophlebitis of the legs: still a lot to learn. J Thromb Haemost. 2005;3(6):1149–51. DOI: 10.1111/j.1538–7836.2005.01445.x.

5. Saveliev V.S., Gologorsky V.A., Kiriyenko A.I. Phlebology. A guide for doctors. Ed. V.S. Savelyev. [Flebologiya. Rukovodstvo dlya vrachej. Pod red. V.S. Savel’eva]. Moskva: Medicina, 2001. 664 s.(In Russ.).

6. Verlato F., Zucchetta P., Prandoni P. et al. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg. 1999;30(6):1113–5. DOI: 10.1016/ s0741–5214(99)70051–0.
7. Superficial Thrombophlebitis Treated by Enoxaparin Study Group. A pilot randomized double-blind comparison of low-molecularweight heparin, nonsteroidal anti-inflammatory agent, and placebo in the treatment of superficial vein thrombosis. Arch Intern Med. 2003;163(14):1657–63. DOI: 10.1001/archinte.163.14.1657.
8. Decousus H., Quere I., Presles E. et al. Superficial venous thrombosis and venous thromboembolism: a large, prospective epidemiologic study. Ann Intern Med. 2010;152(4):218–24. DOI: 10.7326/0003-4819-152-4-201002160-00006.
9. Karathanos C., Exarchou M., Tsezou A. et al. Factors associated with the development of superficial vein thrombosis in patients with varicose veins. Thromb Res. 2013;132(1):47–50. DOI: 10.1016/j. thromres.2013.05.017.
10. Decousus H., Bertoletti L., Frappe P. Spontaneous acute superficial vein thrombosis of the legs: do we really need to treat? J Thromb Haemost. 2015;13(Suppl 1):230–7. DOI: 10.1111/jth.12925.
11. Khryshchanovich V. Ya. Diagnostics and management of superficial vein thrombosis. [Diagnostika i lechenie poverhnostnogo tromboflebita]. Kardiologiya v Belarusi. 2018;(3):339–48. (In Russ.).
12. Pavlova V. Yu. Review of current normative documentation in healthcare service. [Obzor sovremennoj normativnoj dokumentacii v zdravoohranenii]. Tromboz, gemostaz i reologiya. 2019;(2):5–11. DOI: 10.25555/THR.2019.2.0874. (In Russ.).
13. ZabolotskikhI.B., Kirov M.Yu., AfonchikovV.S. et al. Perioperative management of patients receiving long-term antithrombotic therapy. Russian Federation of anesthesiologists and reanimatologists guidelines. [Perioperacionnoe vedenie pacientov, poluchayushchih dlitel’nuyu antitromboticheskuyu terapiyu. Klinicheskie rekomendacii Federacii anesteziologov i reanimatologov]. Vestnik intensivnoj terapii imeni A.I. Saltanova. 2019;(1):7–19. (In Russ.). DOI: 10.21320/1818–474X-2019-1-7-19.
14. Stoyko Yu.M., Kirienko A.I., Ilyukhin E.A. et al. Diagnostics and treatment of superficial thrombophlebitis. Guidelines of the Russian Phlebological Association. [Diagnostika i lechenie tromboflebita poverhnostnyh ven konechnostej. Rekomendacii Associacii flebologov Rossii]. Flebologiya. 2019;13(2):78–97. DOI: 10.17116/ flebo20191302178. (In Russ.).