Oberflächliche Venenthrombose der Beinvenen – Eine systematische Übersicht – Teil 2: Therapie

Zusammenfassung

Einleitung Die oberflächliche Venenthrombose (OVT) der Beinvenen ist mit einer Inzidenz von 0,5–1/1000 Einwohner/Jahr ein häufiges und mit einer Frequenz assoziierter thromboembolischer Ereignisse in bis zu 25 % der Fälle ein ernst zu nehmendes Krankheitsbild. In der vorliegenden Übersichtsarbeit sollen alle relevanten Aspekte der OVT basierend auf der aktuellen wissenschaftlichen Literatur behandelt werden.

Methoden Die systematische Übersicht umfasst das Wissen über die OVT basierend auf dem gesamten, systemisch recherchierten Erkenntnismaterial in den Datenbanken PubMed und Google Scholar. Eine Literaturrecherche in PubMed von Publikationen (1968–2018) mit den Suchbegriffen „Superficial vein thrombosis; thrombophlebitis“ ergab 102 aussagekräftige Arbeiten, die nach Vorlage der Originalarbeit ausgewertet wurden. Teil 2 der Arbeit behandelt Aspekte zur Therapie.

Ergebnisse Die Bewertungskriterien der Therapie der OVT sind in den einzelnen Leitlinien und Übersichtsarbeiten z. T. unterschied­lich. Andererseits ist in den letzten Jahren eine zunehmende Stringenz in den Therapieempfehlungen festzustellen, die vom Ausprägungsgrad der OVT abhängig sind. Zu deren Prinzipien gehören die Mobilisation des Patienten und das Tragen eines medizinischen Kompressionsstrumpfes der Kompressionsklasse II. Die medikamentöse Therapie umfasst den Einsatz von Fondaparinux oder niedermolekularen Heparinen. Fondaparinux ist derzeit das einzig zugelassene Medikament für diese Indikation ab einer Thrombusausdehnung von mindestens 5 cm. Rivaroxaban in einer Tagesdosis von 10 mg war gegenüber Fondaparinux in einer randomisierten Studie nicht unterlegen; dies führte jedoch nicht zu einer Zulassung für die Indikation der OVT. Eine therapeutische Antikoagulation hingegen wird empfohlen, sobald sich das proximale Thrombusende 3 cm oder näher zum Übergang in das tiefe Venensystem befindet. Nichtsteroidale Antirheumatika reduzieren das Risiko einer OVT-Extension oder eines Rezidivs und wirken schmerzlindernd. Die Therapie mit Externa bietet nur lokale symptomlindernde Effekte. Eine operative Therapie der OVT kann in bestimmten Situationen erwogen werden, um Varizen, Schmerzen und das Risiko einer Thrombusaszension in einem Behandlungsschritt zu beseitigen.

Schlussfolgerung Aufgrund der Häufigkeit und des Risikos potenziell lebensbedrohender Komplikationen sollte der OVT der Beinvenen eine größere Beachtung zukommen, insbesondere mit Blick auf eine auf den individuellen Befund ausgerichtete Stadien-adaptierte Therapie.

Abstract

Introduction Superficial vein thrombosis (SVT) of the leg veins arises with an incidence of 0,5–1 per 1000 persons per year and is complicated by associated thromboembolic events in 1 out of 4 cases. Thereby SVT is a frequent and serious venous disease. This review covers all relevant aspects of SVT based on the current scientific literature.

Methods This review article comprises the entire knowledge about SVT and is based on a systematic PubMed and Google Scholar search. Selective literature analysis based on a systematic PubMed search of publications between 1968 and 2018 with search terms „superficial vein thrombosis; thrombophlebitis” yielded in 102 relevant publications which were evaluated for this review. Part 2 of this work compiles aspects of treatment.

Results Current guidelines and reviews propose different criteria and recommendations for SVT treatment, whereupon an increasing stringency in the therapy recommendations in recent years can be observed. The correct choice of treatment depends on the individual extent of SVT. Principles of the treatment are patient’s mobilization and the wearing of compression stockings. A treatment with fondaparinux or low-molecular-weight heparin (LMWH) should be considered keeping in mind that Fondaparinux is exclusively approved for SVT treatment in patients with a thrombus length of at least 5 cm. Rivaroxaban with a daily dose of 10 mg was not inferior to Fondaparinux in a single randomized trial, but this did not lead to an approval for SVT. However, a therapeutic full-dose anticoagulation is recommended as soon as the thrombus reached a distance of 3 cm or less to the deep vein system. Non-steroidal anti-inflammatory drugs reduce the risk of an extension of SVT or its recurrence and they reduce pain. A surgical treatment of SVT can be weighed in particular situations to remove varicose veins and eliminate pain and the risk of thrombus ascension within a single step.

Conclusion Because of its high frequency and the risk of potentially life-threatening complications SVT of the leg veins should be more focused, especially in terms of a specific treatment based upon the individual extent of the disease.

Schlüsselwörter

oberflächliche Venenthrombose - Thrombophlebitis - Therapie

Key words

superficial vein thrombosis - thrombophlebitis - treatment

Publication History

Article published online:
25 May 2021

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