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The New England Journal of Medicine Mar 2019
Topics: Adolescent; Chest Pain; Fusobacterium necrophorum; Humans; Jugular Veins; Lemierre Syndrome; Lung; Male; Radiography, Thoracic; Thrombophlebitis; Tomography, X-Ray Computed
PubMed: 30893539
DOI: 10.1056/NEJMicm1808378 -
The Cochrane Database of Systematic... Feb 2018The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The optimal treatment of superficial thrombophlebitis (ST) of the legs remains poorly defined. While improving or relieving the local painful symptoms, treatment should aim at preventing venous thromboembolism (VTE), which might complicate the natural history of ST. This is the third update of a review first published in 2007.
OBJECTIVES
To assess the efficacy and safety of topical, medical, and surgical treatments for ST of the leg in improving local symptoms and decreasing thromboembolic complications.
SEARCH METHODS
For this update, the Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register (March 2017), CENTRAL (2017, Issue 2), and trials registries (March 2017). We handsearched the reference lists of relevant papers and conference proceedings.
SELECTION CRITERIA
Randomised controlled trials (RCTs) evaluating topical, medical, and surgical treatments for ST of the legs that included people with a clinical diagnosis of ST of the legs or objective diagnosis of a thrombus in a superficial vein.
DATA COLLECTION AND ANALYSIS
Two authors assessed the trials for inclusion in the review, extracted the data, and assessed the quality of the studies. Data were independently extracted from the included studies and any disagreements resolved by consensus. We assessed the quality of the evidence using the GRADE approach.
MAIN RESULTS
We identified three additional trials (613 participants), therefore this update considered 33 studies involving 7296 people with ST of the legs. Treatment included fondaparinux; rivaroxaban; low molecular weight heparin (LMWH); unfractionated heparin (UFH); non-steroidal anti-inflammatory drugs (NSAIDs); compression stockings; and topical, intramuscular, or intravenous treatment to surgical interventions such as thrombectomy or ligation. Only a minority of trials compared treatment with placebo rather than an alternative treatment and many studies were small and of poor quality. Pooling of the data was possible for few outcomes, and none were part of a placebo-controlled trial. In one large, placebo-controlled RCT of 3002 participants, subcutaneous fondaparinux was associated with a significant reduction in symptomatic VTE (risk ratio (RR) 0.15, 95% confidence interval (CI) 0.04 to 0.50; moderate-quality evidence), ST extension (RR 0.08, 95% CI 0.03 to 0.22; moderate-quality evidence), and ST recurrence (RR 0.21, 95% CI 0.08 to 0.54; moderate-quality evidence) relative to placebo. Major bleeding was infrequent in both groups with very wide CIs around risk estimate (RR 0.99, 95% CI 0.06 to 15.86; moderate-quality evidence). In one RCT on 472 high-risk participants with ST, fondaparinux was associated with a non-significant reduction of symptomatic VTE compared to rivaroxaban 10 mg (RR 0.33, 95% CI 0.03 to 3.18; low-quality evidence). There were no major bleeding events in either group (low-quality evidence). In another placebo-controlled trial, both prophylactic and therapeutic doses of LMWH (prophylactic: RR 0.44, 95% CI 0.26 to 0.74; therapeutic: RR 0.46, 95% CI 0.27 to 0.77) and NSAIDs (RR 0.46, 95% CI 0.27 to 0.78) reduced the extension (low-quality evidence) and recurrence of ST (low-quality evidence) in comparison to placebo, with no significant effects on symptomatic VTE (low-quality evidence) or major bleeding (low-quality evidence). Overall, topical treatments improved local symptoms compared with placebo, but no data were provided on the effects on VTE and ST extension. Surgical treatment combined with elastic stockings was associated with a lower VTE rate and ST progression compared with elastic stockings alone. However, the majority of studies that compared different oral treatments, topical treatments, or surgery did not report VTE, ST progression, adverse events, or treatment adverse effects.
AUTHORS' CONCLUSIONS
Prophylactic dose fondaparinux given for 45 days appears to be a valid therapeutic option for ST of the legs for most people. The evidence on topical treatment or surgery is too limited and does not inform clinical practice about the effects of these treatments in terms of VTE. Further research is needed to assess the role of rivaroxaban and other direct oral factor-X or thrombin inhibitors, LMWH, and NSAIDs; the optimal doses and duration of treatment in people at various risk of recurrence; and whether a combination therapy may be more effective than single treatment. Adequately designed and conducted studies are required to clarify the role of topical and surgical treatments.
Topics: Anti-Inflammatory Agents, Non-Steroidal; Anticoagulants; Factor Xa Inhibitors; Fondaparinux; Hemorrhage; Heparin, Low-Molecular-Weight; Humans; Polysaccharides; Randomized Controlled Trials as Topic; Rivaroxaban; Stockings, Compression; Thrombectomy; Thromboembolism; Thrombophlebitis; Venous Thromboembolism
PubMed: 29478266
DOI: 10.1002/14651858.CD004982.pub6 -
Cleveland Clinic Journal of Medicine Apr 2020
Topics: Aged; Humans; Leg; Male; Thrombophlebitis
PubMed: 32238373
DOI: 10.3949/ccjm.87a.19086 -
Deutsches Arzteblatt International Feb 2020
Topics: Aged, 80 and over; Humans; Male; Thrombophlebitis
PubMed: 32181733
DOI: 10.3238/arztebl.2020.0125 -
European Annals of Otorhinolaryngology,... Apr 2016Lemierre syndrome is a complication of oropharyngeal infection and consists of a combination of internal jugular vein septic thrombophlebitis with septicaemia and...
INTRODUCTION
Lemierre syndrome is a complication of oropharyngeal infection and consists of a combination of internal jugular vein septic thrombophlebitis with septicaemia and distant septic emboli (mainly in the lungs). We describe an atypical case with facial vein and anterior jugular vein thrombophlebitis.
CASE SUMMARY
A 34-year-old woman attended the emergency room with tonsillitis, left head and neck cellulitis, left facial vein thrombosis and lung abscesses. A diagnosis of atypical Lemierre syndrome was proposed and the patient was treated surgically (neck incision and tonsillectomy) and medically (antibiotics, hyperbaric oxygen therapy and anticoagulation) allowing cure without sequelae.
DISCUSSION
Lemierre syndrome, a rare but serious complication requiring immediate treatment, should be investigated (by blood cultures and chest CT scan) in the presence of neck vein thrombosis complicating oropharyngeal infection.
Topics: Adult; Face; Female; Humans; Jugular Veins; Lemierre Syndrome; Thrombophlebitis
PubMed: 26718846
DOI: 10.1016/j.anorl.2015.12.001 -
Tidsskrift For Den Norske Laegeforening... May 2018
Topics: Aged; Breast Diseases; Conservative Treatment; Female; Humans; Middle Aged; Thrombophlebitis; Veins
PubMed: 29808659
DOI: 10.4045/tidsskr.18.0091 -
Schweizer Archiv Fur Tierheilkunde Sep 2017Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential... (Review)
Review
Intravenous catheterization is a necessity for continuous administration of intravenous fluids and for intermittent intravenous access to avoid discomfort and potential complications of repeated needle insertions into the vein. Intravenous catheterization is commonly performed and well tolerated in horses, but catheter associated complications have been reported. The most commonly reported complication is thrombophlebitis, but others such as venous air embolism, exsanguination and catheter fragmentation may also occur. This article aims to review clinical signs, pathogenesis, diagnosis, therapy, risk factors and prevention of common catheter associated complications.
Topics: Animals; Catheterization, Peripheral; Embolism, Air; Exsanguination; Horse Diseases; Horses; Prognosis; Risk Factors; Thrombophlebitis; Vascular Access Devices
PubMed: 28952957
DOI: 10.17236/sat00126 -
Thrombosis Research Dec 2020Lemierre syndrome is a rare but potentially fatal condition characterized by septic thrombophlebitis of the head and neck district, preferentially affecting adolescents... (Review)
Review
Lemierre syndrome is a rare but potentially fatal condition characterized by septic thrombophlebitis of the head and neck district, preferentially affecting adolescents and young adults and manifesting as a complication of a local bacterial infection - typically, a pharyngotonsillitis or an abscess. It is historically associated with the Gram-negative anaerobic rod Fusobacterium necrophorum and with thrombophlebitis of the internal jugular vein. However, its definition has never been firmly established, and its spectrum within the continuum of bacteria-associated thrombophlebitis may be larger than what presumed so far. Recent evidence suggests that its prognosis remains serious even one hundred years after its first description, with considerable rates of in-hospital complications, death, and long-term sequelae. There are no specific guidelines on its management other than usual antibiotic stewardship, with ongoing debate on the potential role of therapeutic-dose anticoagulation. We provide an overview of current evidence on the definition, epidemiology, clinical presentation, prognosis and management of this condition and present the background and rationale of the Bacteria-Associated Thrombosis/Thrombophlebitis and LEmierre syndrome (BATTLE) registry: an ambispective, disease-specific, non-population based, multicentre clinical registry of global reach and multidisciplinary scope, specifically designed to address the limitations of current evidence and to provide patients and physicians with clinically viable information to guide management and improve the outcomes of those affected by these conditions.
Topics: Adolescent; Anti-Bacterial Agents; Fusobacterium necrophorum; Humans; Jugular Veins; Lemierre Syndrome; Registries; Thrombophlebitis; Young Adult
PubMed: 33091703
DOI: 10.1016/j.thromres.2020.10.002 -
The Neuroradiology Journal Dec 2023Thrombophlebitis is a known complication of head and neck infection, which can result in propagation of infected thrombi and associated complications. While...
Thrombophlebitis is a known complication of head and neck infection, which can result in propagation of infected thrombi and associated complications. While antegrade/downstream propagation of thrombus is well described-the Lemierre syndrome-thrombophlebitis can spread in atypical patterns which has specific diagnostic and treatment considerations. In this series, we highlight 6 cases of atypical thrombophlebitis patterns complicating head and neck infection, 5 of which extend intracranially. Through these pathways, head and neck infections such as oral cavity, oropharynx, or skin can be the culprit of remote, including intracranial, complications, which may be overlooked. Furthermore, understanding pathways of venous drainage and communication can help accurately diagnose thrombophlebitis patterns and associated complications.
Topics: Humans; Thrombophlebitis; Lemierre Syndrome
PubMed: 36912438
DOI: 10.1177/19714009231163564 -
Internal Medicine (Tokyo, Japan) Sep 2018Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign... (Review)
Review
Mondor's disease (MD) is a rare disease that manifests with a palpable cord-like induration on the body surface. In general, MD is a self-limited, benign thrombophlebitis that resolves in four to eight weeks without any specific treatment. Cases of MD can be roughly categorized into three different groups based on the site of the lesion as follows: original MD of the anterolateral thoracoabdominal wall, penile MD with dorsum and dorsolateral aspects of the penis, and axillary web syndrome with mid-upper arm after axillary surgery. The diagnosis of MD is rather straightforward and based on a physical examinations. However, some case occur "secondary" with another underlying disease, including malignancy, a hypercoagulative state, and vasculitis. Therefore, it is critical to identify MD precisely, evaluate any possible underlying disease, and avoid any unnecessary invasive tests or treatment. In this paper, we comprehensively review the clinical characteristics of MD.
Topics: Arm; Humans; Male; Penile Diseases; Rare Diseases; Thrombophlebitis
PubMed: 29780120
DOI: 10.2169/internalmedicine.0495-17