Oberflächliche Venenthrombose

Was ist neu?

Epidemiologie und Risikofaktoren Eine deutsche Registerstudie zeigt, dass Risikoprofile, klinisches Bild und Behandlungsmuster bei oberflächlicher Venenthrombose (OVT) sehr heterogen sind. Ebenso variieren Dosierung und Therapiedauer der Antikoagulation (AK) erheblich. Trotz initialer AK besteht nach 3 Monaten ein beachtliches Risiko für venöse Thromboembolien (VTE), Rezidive oder Ausdehnung. Im Gegensatz zu aktuellen Leitlinienempfehlungen erhielt ein Drittel der Patienten entweder Heparine, orale Antikoagulanzien oder gar kein Antikoagulans. Eine gleichzeitige, oft asymptomatische tiefe Venenthrombose (TVT) findet sich gehäuft nach Hospitalisierung oder Immobilisation, vorausgegangener VTE, bei Autoimmunerkrankungen, höherem Alter, Malignom und bei OVT in einer nichtvarikösen Vene oder bei Ausdehnung in eine Perforansvene. Dies sind häufig auch Risikofaktoren für thromboembolische Komplikationen im Verlauf.

Therapie Aufgrund einer großen Placebo-kontrollierten Studie mit klinischen Endpunkten ist Fondaparinux 1-mal 2,5 mg über 4–6 Wochen die in den Leitlinien empfohlene Therapie. Auch eine intermediäre Dosis von niedermolekularem Heparin (NMH) kann erwogen werden. Bei Hochrisikopatienten war 1-mal 10 mg Rivaroxaban gegenüber Fondaparinux nicht unterlegen. Ob bei hohem Risiko eine 45-tägige Therapie ausreicht, muss weiter untersucht werden.

What is New?

Epidemiology and risk factors A large German registry on superficial vein thrombosis (SVT) documents that risk profiles, clinical presentation and treatment patterns are highly variable in patients with SVT, including a large variation in anticoagulation treatment modalities, intensities and durations. Inspite of a high percentage of initial anticoagulation there is a substantial risk of subsequent venous thromboembolism (VTE), recurrences or extension after three months. Inspite of current guideline recommendations, one third of the patients receives heparins, oral anticoagulants or no anticoagulation at all. At initial presentation about one quarter of the patients with SVT have a concomitant, frequently asymptomatic VTE. Risk factors for this complication include prior hospitalization, immobilization, prior VTE, autoimmune disorders, higher age, cancer and SVT occurring in a non-varicose veins or SVT-extension into the perforator veins. These risk factors are also associated with thromboembolic complications during follow-up.

Treatment Based on a large placebo-controlled trial with clinical endpoints (The CALISTO-Study), guidelines recommend Fondaparinux 2.5 mg once daily administered over 4 to 6 weeks. Alternatively, an intermediate dose of low molecular weight heparin can be considered. In high-risk patients, rivaroxaban 10 mg once daily was noninferior compared to Fondaparinux. A rebound of VTE recurrences was observed in both study arms after treatment had been discontinued after 45 days. Further studies are required to determine whether treatment needs to be extended beyond 45 days in high-risk patients.

Schlüsselwörter

oberflächliche Venenthrombose - venöse Thromboembolie - Antikoagulation - niedermolekulares Heparin - Fondaparinux

Key words

superficial vein thrombosis - venous thromboembolism - anticoagulation - low molecular weight heparin - Fondaparinux

Publication History

Article published online:
22 September 2021

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