Therapeutic considerations for patients with SVT
| Therapy . | Considerations . | Comments (references) . |
|---|---|---|
| Passive therapy | 1. Observation, bed rest, and immobility | Not always effective; fatalities occur (1) |
| 2. Serial US surveillance | Passive therapy marginally effective at best (15) | |
| Active nonanticoagulant therapy | 1. Look for coexisting VTE or progression to VTE | These findings might justify systemic therapy (29) |
| 2. Screen for hypercoagulability/thrombophilia | May impact therapeutic decision (23, 25) | |
| 3. NSAIDs/antibiotics | Not thought to be effective (15, 23, 29) | |
| 4. Topical anticoagulants and/or antiplatelet agents | Not thought to be effective (15, 29) | |
| 5. Surgery | May actually exacerbate VTE (27); 7%-10% complication rate (30, 31); not recommended (14) | |
| Active anticoagulant therapy | 1. Systemic administration of anticoagulants | In studies to date, seems useful yet too little administered over too brief a time (15, 23); appears safer and more economical than surgery (31) |
| 2. Extant case series are few and use very brief therapy and typically at low intensity, yet heparin-based therapy seems to be rational, efficacious, and safe; economic considerations are currently not established | 14, 15, 20, 32, 32 | |
| 3. The only RCT (CALISTO) demonstrates that prophylactic doses of fondaparinux compared with placebo is efficacious, safe, and durable | 34 |
| Therapy . | Considerations . | Comments (references) . |
|---|---|---|
| Passive therapy | 1. Observation, bed rest, and immobility | Not always effective; fatalities occur (1) |
| 2. Serial US surveillance | Passive therapy marginally effective at best (15) | |
| Active nonanticoagulant therapy | 1. Look for coexisting VTE or progression to VTE | These findings might justify systemic therapy (29) |
| 2. Screen for hypercoagulability/thrombophilia | May impact therapeutic decision (23, 25) | |
| 3. NSAIDs/antibiotics | Not thought to be effective (15, 23, 29) | |
| 4. Topical anticoagulants and/or antiplatelet agents | Not thought to be effective (15, 29) | |
| 5. Surgery | May actually exacerbate VTE (27); 7%-10% complication rate (30, 31); not recommended (14) | |
| Active anticoagulant therapy | 1. Systemic administration of anticoagulants | In studies to date, seems useful yet too little administered over too brief a time (15, 23); appears safer and more economical than surgery (31) |
| 2. Extant case series are few and use very brief therapy and typically at low intensity, yet heparin-based therapy seems to be rational, efficacious, and safe; economic considerations are currently not established | 14, 15, 20, 32, 32 | |
| 3. The only RCT (CALISTO) demonstrates that prophylactic doses of fondaparinux compared with placebo is efficacious, safe, and durable | 34 |
US indicates ultrasound; and NSAIDs, nonsteroidal anti-inflammatory drugs.