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Three Part Question

In [adult patients presenting with a clinical diagnosis of superficial venous thrombosis] is [anticoagulation rather than conservative management] more effective at [reducing the morbidity and mortality associated with thromboembolic complications]

Clinical Scenario

A middle aged woman who is previously fit and well arrives at your ED department concerned about her painful, red and swollen leg. She has been advised by her GP receptionist that "It is probably a DVT. Get yourself down to casualty and have it checked out". You notice a red, swollen area on her thigh along the distribution of her great saphenous vein. It is tender and warm to touch. You make a clinical diagnosis of "superficial venous thrombosis" - but have recently heard that there is a high incidence of concurrent DVT with this condition. Ordinarily you would have sent her on her way with instructions to mobilise and to take regular NSAIDs, however, you wonder whether anticoagulation might be an appropriate treatment option.

Search Strategy

exp. Thromboembolism/ or exp. Thrombosis/ or exp. Venous thromboembolism/ or superficial venous thrombosis.mp or exp. Venous thrombosis/ or exp. Thrombophlebitis or SVT.mp or ST.mp
AND
exp. Saphenous vein/ or superficial vein.mp or saphenofemoral.mp or saphenopopliteal.mp or exp. Varicose veins/ or lower limb.mp or exp. lower extremity or leg.mp or exp. Leg/
AND
LMWH.mp or exp. Heparin, low molecular weight/ or anticoagulant.mp or exp. Anticoagulants/ or exp. Heparin/ or heparin.mp or warfarin.mp or exp. Warfarin/ or coumarin.mp or exp.coumarins/ or exp. Enoxaparin/ or fondaparinux.mp or factor Xa inhibitor.mp or clexane.mp or tinzaparin.mp or dalteparin.mp or thrombolytic therapy.mp or exp. Thrombolytic therapy/ or innohep.mp or fragmin.mp or certoparin.mp or reviparin.mp or parnaparin.mp or embolex.mp or sandoparin.mp or ardeparin.mp or normiflo.mp or fluxum.mp or clivarin.mp or fraxiparin.mp
Limit to Human and English
Cochrane Database of Systematic Reviews
Using Ovid Interface - Medline 1948 to April 2011
EMBASE 1985 to April 2011
CINAHL 1985 to April 2011
British Nursing Index 1985 to April 2011
Hand search of references

Search Outcome

A recent Cochrane Review which was directly relevent was found.
Allowing for overlap, 152 relevent journal articles were found via the databases. These were reviewed by title and abstract. 10 articles were directly relevent to the three part question and these are summarised in the table of evidence below: