gms | German Medical Science

Background: The outdated consideration about superficial vein thrombosis (SVT) as a benign and self-limiting condition, not requiring anticoagulant therapy has been completely changed on arrival of new data indicating a high risk of venous thromboembolism (VTE) in 3 months following the first episode of thrombophlebitis and persistence of this trend up to 5 years of observations [1]. Meanwhile, Sulodexide showed extremely high efficacy in VTE prophylaxis without increasing the rate of major bleeding in a SURVET study [2]. This drug possesses anti-inflammatory properties thus reducing glycocalyx dysfunction (plays an important role in the pathogenesis of SVT [3], [4]), making possible the reduction of tributary superficial vein thrombosis symptoms and reducing the risk of secondary VT. This is the hypothesis of this study.

Methods: 72 patients with clinical signs of SVT in the great saphenous vein GSV (61 patients) and small saphenous vein SSV (11 patients) system were identified. According to ultrasound data, trunks’ valves were incompetent, and thrombosis was limited by GSV or SSV tributaries in all patients. The average term of clinical thrombophlebitis manifestation was 6 ± 3.2 days. All patients had got conservative therapy, including nonsteroidal anti-inflammatory drugs, 2^nd class compression stockings. 12 patients had got prophylactic doses of low molecular weight heparin at one week due to severe clinical symptoms. All patients administered 500 lipasemic units of Sulodexide twice daily for 3 months. The primary endpoint was the elongation of thrombosis to the saphenous veins’ trunks, as well VTE symptoms within 3 months according to clinical signs and ultrasound examination.

Results: In 76% of patients, recanalization of the tributaries was observed after one-month treatment. All patients noted significant clinical improvement after first week of treatment. Thrombosis elongation to saphenous trunks was found in 5 (7%) patients. The recurrence rate of VTE was 1.4% (recurrent episode of STV in 1 patient). There were no serious adverse events (bleeding or pulmonary embolism during treatment.

Conclusion: Sulodexide seems to be effective and safe in treatment of tributary superficial vein thrombosis, thus reducing the incidence of secondary VTE after the first episode of SVT. Further clinical investigations are needed to determine the effectiveness of sulodexide for superficial vein thrombosis treatment.