На ссылке выше показана схематика принятия решения и ведения в зависимости от протяженности и сопутств. патологии [Ссылки доступны только зарегистрированным пользователям ]
еще о тромбофилии и тромбозе поверхн. вен:
Thrombophilia and Superficial Venous Thrombosis
SVT is a relatively common disorder that affects 3%-11% of the population.31 The condition has previously been regarded as benign and treatment has been targeted toward alleviating symptoms, mainly with nonsteroidal antiinflammatory drugs and heat packs. However, studies show that there is a strong correlation between SVT and thrombophilic states32,33 and that thrombophilias are more common when SVTs occur in non-varicosed segments of vein.34
The progression of SVT to DVT varies widely between different studies from the range of 4%-44%.32-34 Furthermore, the progression to DVTs varies depending on location of the SVTs. For example, SVT of the proximal saphenous trunk is generally considered most prone to progress to DVT with rates greater than 27%.35 However, perforating veins can also provide a route for thrombus extension to deep veins.
The presence of thrombophilia and spontaneous SVT seems to correlate with progression of SVT to DVT. Studies have also shown that in patients with SVT, there will be a significantly higher incidence of thrombophilias in patients with SVTs that propagate to the deep veins than in patients with SVTs that do not extend to the deep veins.34 Further, patients with SVT and hypercoagulable states are much more likely to develop new DVTs on prospective follow-up (41.7% vs 4.2% in one study).32
Prior to 2010, there had been 5 randomized trials of treatment of SVT with mixed results.36-40 However, a newer randomized control trial of over 3000 patients showed that anticoagulation for 45 days resulted in a significant reduction of PE, DVT, and recurrent SVT compared to treatment with placebo.41
As of yet there have been no studies that look at the effect of thrombophilia in the treatment of patients with SVT. There also aren’t any studies of the rate of PEs in patients with SVT as a function of presence of thrombophilia. These are 2 important areas that mandate investigation. Current CHEST guidelines support the use of low or intermediate LMWH, intermediate dose UFHR, or LMWH as a bridge to VKA for 4 weeks as treatment in most cases of spontaneous SVT. However, SVT is still managed conservatively in most cases and its true potential for thromboembolic complications may be underestimated. Randomized studies of anticoagulation versus observation in patients with SVT and concomitant thrombophilia may identify a patient group that would have a greater benefit from anticoagulation after SVT.
A history of spontaneous SVT is an important consideration when planning venous surgery for reflux or varicose veins. At least one study has shown that previous SVT correlates with development of DVT after RFA of the greater saphenous vein.29 This correlation suggests that SVT patients may likely benefit from perioperative pharmacologic DVT prophylaxis, as well as early mobilization and compression wraps. However, the efficacy of these interventions in these patients requires prospective analysis. Furthermore, patients with spontaneous SVTs may also represent a group in which testing for a thrombophilia may be of benefit.
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