Content

2. Content Introduction • Definition • Causes • Risk Factors • Symptoms • Importance • Treatments • Data to extract from the articles • Variables for data extraction Results Aims • Study type • Follow-up • Participants • Treatments applied Methods • Collecting Articles • Research Question • Query • Inclusion / Exclusion criteria Conclusions

3. Introduction Aims Results Methods Conclusions Definition Superficial venous thrombosis consists in the formation of a blood clot in a superficial vein. Most commonly, it affects the lower limbs. Under normal physiological conditions, there is a continuous formation of clots in the veins, but they disintegrate rapidly, not causing any harm. Superficial Venous Thrombosis of the Lower Limbs

4. Introduction Aims Results Methods Conclusions Risk Factors Varicose veins; Hormone therapy; Family history; History of malignancy; Cigarette smoking; Obesity; Diabetes… Uncu H., 2009 Superficial Venous Thrombosis of the Lower Limbs

5. Introduction Aims Results Methods Conclusions Causes Superficial Venous Thrombosis of the Lower Limbs

6. Introduction Aims Results Methods Conclusions Symptoms • Pain • Rednessoftheskinwithincreaseoftemperature • Induration • Edema (swelling) • Fever Superficial Venous Thrombosis of the Lower Limbs

7. Introduction Aims Results Methods Conclusions Importance The thrombus can reach the deep venous system through:

8. Introduction Aims Results Methods Conclusions Importance - statistics Superficial venous thrombosisrarely causes serious complications, BUT In some cases, SVT can evolve (Litzendorf and Satiani, 2011): 6-40% - Deep Venous Thrombosis (DVT); 2-13% - Pulmonary embolism. Superficial Venous Thrombosis of the Lower Limbs

9. Introduction Aims Results Methods Conclusions Treatment temporal evolution * There is still no consensus about using surgery as a possible treatment. Therefore, in some cases, it is still used. (Decousus H, Epinat M, Guillot K, 2003) Superficial Venous Thrombosis of the Lower Limbs

10. Introduction Aims Results Methods Conclusions Treatments If SVT has a historylongerthanoneweek, medical therapyisconsidered to be more effectivethansurgicaltherapy(Bergqvist D, Brunkwell J, Jensen N, PerssonNH 1990) Superficial Venous Thrombosis of the Lower Limbs

11. Introduction Aims Results Methods Conclusions Costs (BelcaroG. et al, 1999) Superficial Venous Thrombosis of the Lower Limbs

12. Introduction Aims Results Methods Conclusions Aims • Discovering the possible treatments • Evaluate their results and complications Superficial Venous Thrombosis of the Lower Limbs

13. Introduction Aims Results Methods Conclusions Collecting Articles Databasesused: • Pubmed • Scopus • ISI Web ofKnowledge Superficial Venous Thrombosis of the Lower Limbs

14. Introduction Aims Results Methods Conclusions Research Question: Which are theresultsandcomplicationsof Superficial VenousThrombosis’ treatments? Superficial Venous Thrombosis of the Lower Limbs Superficial Venous Thrombosis of the Lower Limbs

15. Introduction Aims Results Methods Conclusions Aim to achieve with the queries Ouraim Superficial Venous Thrombosis of the Lower Limbs

16. Introduction Aims Results Methods Conclusions Query - Pubmed

17. Introduction Aims Results Methods Conclusions Query - Pubmed Superficial Venous Thrombosis of the Lower Limbs

18. Introduction Aims Results Methods Conclusions Query - Pubmed Superficial Venous Thrombosis of the Lower Limbs

19. Introduction Aims Results Methods Conclusions Query - Scopus Superficial Venous Thrombosis of the Lower Limbs

20. Introduction Aims Results Methods Conclusions Query - ISI Web ofKnowledge

21. Introduction Aims Results Methods Conclusions Query - ISI Web ofKnowledge Superficial Venous Thrombosis of the Lower Limbs

22. Introduction Aims Results Methods Conclusions Outcome • Articles obtained: Deadline for the research of the articles: March 22, 2012 Superficial Venous Thrombosis of the Lower Limbs

23. Introduction Aims Results Methods Conclusions Flowchart

24. Introduction Aims Results Methods Conclusions First selection phase

25. Introduction Aims Results Methods Conclusions Inclusionand exclusion criteria Inclusion Criteria Exclusion Criteria • Studies that fully describe the treatment applied in SVT; • Studies describing the evolution of SVT according to the treatment applied. • Articles without original data (ex: systematic review); • Articles not written in English, Portuguese or Spanish; • Articles whose full-text was not available. • Articles describing only one clinical case.

26. Introduction Aims Results Methods Conclusions First selection phase By reading the abstracts a first selection of the articles was made. Excluded - Language - Study Type - Not relevant Included

27. Introduction Aims Results Methods Conclusions Flowchart

28. Introduction Aims Results Methods Conclusions Second selection phase

29. Introduction Aims Results Methods Conclusions Second selection phase Excluded - Not available - Not relevant1 - Repeated Included 1 – Articles in doubt, during the first selection phase, due to their ambiguous abstracts.

30. Introduction Aims Results Methods Conclusions Order of exclusion - summary • Availability 13% of the articles excluded 5% of the articles excluded 73% of the articles excluded 6% of the articles excluded For a total of 361 articles obtained Superficial Venous Thrombosis of the Lower Limbs

31. Introduction Aims Results Methods Conclusions Listofthearticles • 1 – High vs. low doses of low-molecular-weight heparin for the treatment of superficial vein thrombosis of the legs: a double-blind, randomizedtrial • 2 – Superficial ThrombophlebitisoftheLegs: A Randomized, Controlled, Follow-up Study • 3 – Simultaneousoccurrenceofsuperficial and deep thrombophlebitis in the lowerextremity • 4 – High versus low doses of unfractionatedheparin for thetreatmentofsuperficial thrombophlebitisoftheleg. A prospective, controlled, randomizedstudy • 5 – A comparison of low-molecular-weight heparin and combined therapy of low-molecular-weight heparin with an anti-inflammatory agent in the treatment of superficial vein thrombosis

32. Introduction Aims Results Methods Conclusions Listofthearticles • 6 – The use of liposomal heparin spray-gel in the treatmentof superficial thrombophlebitis: a multicenterclinicalinvestigationanalysis; • 7 – A Pilot Randomized Double-blind Comparison of a Low-Molecular-Weight Heparin, a Nonsteroidal Anti-inflammatory Agent, and Placebo in the Treatment of Superficial Vein Thrombosis; • 8 – Prospective five-year study of ultrasound-guided foam sclerotherapy in the treatment of great saphenousveinreflux; • 9 – Fondaparinux for the Treatment of Superficial-Vein Thrombosis in the Legs; • 10 – A retrospective analysis of patients treated for superficial veinthrombosis; • 11 – Fondaparinuxfor Isolated Superficial VeinThrombosisoftheLegs : A Cost-EffectivenessAnalysis;

33. Introduction Aims Results Methods Conclusions

34. Introduction Aims Results Methods Conclusions General table of the articles’ data * LMWH: Low Molecular Weight Heparin

35. Introduction Aims Results Methods Conclusions Variables for data extraction Superficial Venous Thrombosis of the Lower Limbs

36. Introduction Aims Results Methods Conclusions Variables Relative to the article extraction: • Database • Article number • Year • Study Type Relative to article’s content: • Nº of participants • Nº of groups • Follow-up • Drop out • Age • Gender • Treatments • Efficacy Superficial Venous Thrombosis of the Lower Limbs

37. Introduction Aims Results Methods Conclusions Data extraction to SPSS Superficial Venous Thrombosis of the Lower Limbs

38. Introduction Aims Results Methods Conclusions Study Type Superficial Venous Thrombosis of the Lower Limbs

39. Introduction Aims Results Methods Conclusions Follow-up (in days) Article nº Superficial Venous Thrombosis of the Lower Limbs

40. Introduction Aims Results Methods Conclusions Participants Article nº Total of participants: 14 488 Superficial Venous Thrombosis of the Lower Limbs

41. Introduction Aims Results Methods Conclusions Different treatments applied Eleven articles analyzed: a total of 14 488 patients received treatment, 1502 with placebo and 11500 with Fondaparinux. The remaining treatments used are in the chart below.

42. Introduction Aims Results Methods Conclusions Heparin Data Superficial Venous Thrombosis of the Lower Limbs

43. Introduction Aims Results Methods Conclusions Antithrombotictherapyvs placebo (1/2) Data obtained from article 7 * enoxaparin: a kind of heparin (in this case, different doses were used) Superficial Venous Thrombosis of the Lower Limbs

44. Introduction Aims Results Methods Conclusions Antithrombotic therapy vs placebo (2/2) Data obtained from article 9 Superficial Venous Thrombosis of the Lower Limbs

45. Introduction Aims Results Methods Conclusions Elasticcompressionvsanti-coagulantsandsurgery (1/2) Data obtained from article 2 Superficial Venous Thrombosis of the Lower Limbs

46. Introduction Aims Results Methods Conclusions Elasticcompressionvsanti-coagulantsandsurgery (2/2) Data obtained from article 2 Superficial Venous Thrombosis of the Lower Limbs

47. Introduction Aims Results Methods Conclusions Highvslow doses of LMWH Data obtained from article 4 Superficial Venous Thrombosis of the Lower Limbs

48. Introduction Aims Results Methods Conclusions Prophylacticvstherapeutic doses of LMWH Data obtained from article 1 Superficial Venous Thrombosis of the Lower Limbs

49. Introduction Aims Results Methods Conclusions Lipossomalgel-spray heparinvsheparininjections • Lipohep spray-gel is an heparin gel that has recently appeared on the market. Its effect has been compared with subcutaneous injections of heparin (as showed above) . Data obtained from article 6 N – Lipohep: 43 N – injections: 45

50. Introduction Aims Conclusions Methods Results Conclusions (1/3) • Antithrombotic therapy is more effective than placebo and may avoid surgery; • Elastic compression by itself seems not to be a good option of treatment. Although the group involving delayed surgery as treatment had better outcomes, anti-coagulants seem to be a good alternative to it; • High doses of LMWH have better results than low doses.