Treatment for superficial infusion thrombophlebitis of the upper extremity

BACKGROUND: Although superficial thrombophlebitis of the upper extremity
represents a frequent complication of intravenous catheters inserted into the
peripheral veins of the forearm or hand, no consensus exists on the optimal
management of this condition in clinical practice.
OBJECTIVES: To summarise the evidence from randomised clinical trials (RCTs)
concerning the efficacy and safety of (topical, oral or parenteral) medical
therapy of superficial thrombophlebitis of the upper extremity.
SEARCH METHODS: The Cochrane Vascular Group Trials Search Co-ordinator searched
the Specialised Register (last searched April 2015) and the Cochrane Register of
Studies (2015, Issue 3). Clinical trials registries were searched up to April
2015.
SELECTION CRITERIA: RCTs comparing any (topical, oral or parenteral) medical
treatment to no intervention or placebo, or comparing two different medical
interventions (e.g. a different variant scheme or regimen of the same
intervention or a different pharmacological type of treatment).
DATA COLLECTION AND ANALYSIS: We extracted data on methodological quality,
patient characteristics, interventions and outcomes, including improvement of
signs and symptoms as the primary effectiveness outcome, and number of
participants experiencing side effects of the study treatments as the primary
safety outcome.
MAIN RESULTS: We identified 13 studies (917 participants). The evaluated
treatment modalities consisted of a topical treatment (11 studies), an oral
treatment (2 studies) and a parenteral treatment (2 studies). Seven studies used
a placebo or no intervention control group, whereas all others also or solely
compared active treatment groups. No study evaluated the effects of ice or the
application of cold or hot bandages. Overall, the risk of bias in individual
trials was moderate to high, although poor reporting hampered a full appreciation
of the risk in most studies. The overall quality of the evidence for each of the
outcomes varied from low to moderate mainly due to risk of bias and imprecision,
with only single trials contributing to most comparisons. Data on primary
outcomes improvement of signs and symptoms and side effects attributed to the
study treatment could not be statistically pooled because of the between-study
differences in comparisons, outcomes and type of instruments to measure
outcomes.An array of topical treatments, such as heparinoid or diclofenac gels,
improved pain compared to placebo or no intervention. Compared to placebo, oral
non-steroidal anti-inflammatory drugs reduced signs and symptoms intensity.
Safety issues were reported sparsely and were not available for some
interventions, such as notoginseny creams, parenteral low-molecular-weight
heparin or defibrotide. Although several trials reported on adverse events with
topical heparinoid creams, Essaven gel or phlebolan versus control, the trials
were underpowered to adequately measure any differences between treatment
modalities. Where reported, adverse events with topical treatments consisted
mainly of local allergic reactions. Only one study of 15 participants assessed
thrombus extension and symptomatic venous thromboembolism with either oral
non-steroidal anti-inflammatory drugs or low-molecular-weight heparin, and it
reported no cases of either. No study reported on the development of suppurative
phlebitis, catheter-related bloodstream infections or quality of life.
AUTHORS' CONCLUSIONS: The evidence about the treatment of acute infusion
superficial thrombophlebitis is limited and of low quality. Data appear too
preliminary to assess the effectiveness and safety of topical treatments,
systemic anticoagulation or oral non-steroidal anti-inflammatory drugs.