From the Guidelines

The treatment for superficial thrombus is anticoagulation for 45 days, with fondaparinux 2.5 mg daily being a suggested option.

Fondaparinux 2.5 mg daily is suggested over other anticoagulant treatment regimens such as prophylactic- or therapeutic-dose low-molecular-weight heparin (LMWH) 1
Rivaroxaban 10 mg daily can be used as a reasonable alternative for fondaparinux 2.5 mg daily in patients who refuse or are unable to use parenteral anticoagulation 1
Prophylactic-dose fondaparinux or LMWH for 45 days is suggested over no anticoagulation for patients with superficial vein thrombosis (SVT) of the lower limb at increased risk of clot progression to DVT or PE 1

Patients with SVT of the lower limb at increased risk of clot progression to DVT or PE should be considered for anticoagulation therapy 1
Patients with extensive superficial vein thrombosis can be treated with prophylactic-dose fondaparinux or LMWH over no anticoagulation 1

Anticoagulation therapy should be used for 45 days in patients with SVT of the lower limb at increased risk of clot progression to DVT or PE 1

From the Research

The treatment of choice for superficial thrombus is therapeutic/intermediate dose low molecular weight heparin or prophylactic dose fondaparinux administered for 4-6 weeks 2
Other potential therapeutic options include:
- Topical preparations
- Compression therapy (stockings, bandages)
- Medication such as non-steroidal anti-inflammatory drugs (NSAIDs) or anticoagulants (therapeutic or prophylactic doses)
- Surgery, ligation or stripping, of superficial veins
Fondaparinux has been shown to be effective in reducing symptomatic venous thromboembolism (VTE), extension, and recurrence of superficial thrombophlebitis (ST) compared to placebo 3, 4
Low molecular weight heparin (LMWH) and NSAIDs have also been shown to reduce the extension and recurrence of ST, but with no significant effects on symptomatic VTE or major bleeding 3, 4
Topical treatments have been shown to improve local symptoms, but there is limited data on their effects on VTE and ST extension 3, 4
Surgical treatment combined with elastic stockings has been associated with a lower VTE rate and ST progression compared to elastic stockings alone 3, 4

The cost-effectiveness of treatment is a concern and more targeted therapy is required 2
The optimal doses and duration of treatment, as well as the role of combination therapy, need to be further researched 3, 4
The evidence on topical treatment or surgery is too limited to inform clinical practice about the effects of these treatments in terms of VTE 4