Behnood Bikdeli, MD, MS, a clinician-investigator in the Division of Cardiology at Brigham and Women’s Hospital, is the senior author of a new paper in JAMA Clinical Review & Education, Superficial Vein Thrombosis, A Review.
What Prompted You to Conduct This Review?
Superficial vein thrombosis (SuVT) is a condition involving blood clots in veins close to the surface of the skin, most commonly in legs and arms.
It is a commonly encountered clinical condition, both in the outpatient and inpatient setting, and yet there was a lack of top-quality summary papers that pooled the evidence on its prevalence, risk factors and treatment and provided a cohesive reference for clinicians and investigators.
What Causes Superficial Vein Thrombosis (SuVT?
Behnood Bikdeli, MD, MS
SuVT can arise from a variety of causes, including:
- Injury to inner layer of the veins, for examples as a result of an insertion and persistence of an intravenous line.
- Venous stasis—a condition where blood flow in the vein slows down or stops
- Hypercoagulability—an increased tendency to develop blood clots, typically as a byproduct of another condition such as pregnancy or cancer
Each year, between 214,000 and 438,000 people in the U.S. are diagnosed with SuVT. Approximately 10% of those cases progress to more serious conditions such as deep vein thrombosis (DVT) or pulmonary embolism (PE).
Additional risk factors for SuVT include:
- Varicose veins (bulging, enlarged veins that cause pain and itching)
- Pregnancy and the postpartum period
- Active cancer
- Obesity
- The presence of an intravenous catheter
- A history of venous thromboembolism
- Age 60 or older
- Thrombophilia (an abnormality of blood coagulation that increases the likelihood of clots
How Does Superficial Vein Thrombosis Present in the Clinic?
Typical presenting symptoms of SuVT include redness, itching, swelling, pain, hyperpigmentation and a tender, palpable cord (a rope-like structure that can be felt under the skin).
Diagnosis can often be made based on the presence of these symptoms and a physical examination.
For patients in whom there is uncertainty about the diagnosis or the extent of thrombi, ultrasonography should be considered and can help to rule out other conditions with similar symptoms.
How is it SuVT Treated?
Conservative treatment options for SuVTs include warm compresses, compression therapy with elastic compression stockings, NSAIDs, topical creams containing NSAIDs, and limb elevation. More intensive treatment options include systemic anticoagulation drugs and surgery.
Patients may be treated with anticoagulation if they have greater symptom severity, thrombus size greater than 5 cm, proximity to the deep veins (ie, within 3 cm of the deep vein), multiple risk factors that indicate a high risk of worsening without anticoagulation, persistence of symptoms despite conservative treatment.
How Often Do You Encounter Patients with SuVT?
In the inpatient setting we see this all the time. It is often minimized or ignored (especially if associated with catheters) but sometimes SuVTs can become more serious.
In fact, two weeks ago when I was attending the inpatient consult service, we had yet another patient with upper extremity SuVT and some complications.
It is similarly common in patients with cancer. In the outpatient setting, we see it frequently, too, particularly among those with venous varicosities or pregnant individuals.
What are the Key Takeaways for Caregivers and Patients?
Two takeaways for healthcare workers:
- Classic signs and symptoms should raise suspicion for SuVT. If the diagnosis is unclear or there is concern for extension, get an ultrasound
- While many patients improve with conservative management (e.g., warm compress and NSAIDs), if there is no improvement or if the thrombus is extensive (e.g., >5cm in length) consider treatment with anticoagulants (e.g., fondaparinux 2.5mg once daily for 6 weeks)
Two takeaways for patients:
- If you develop a red, swollen (and possibly painful) area in your arms or legs, let your healthcare team (e.g., PCP know). Do not massage the area until then.
- If an SuVT is identified, talk to your healthcare worker about the tradeoffs of taking blood thinner to treat that clot and reducing the risk of future blood thinners
Learn More: Dr. Bikdeli discusses the paper with Mary McDermott, MD, deputy editor of JAMA in this audio interview.
Paper Cited: Piazza, G., Krishnathasan, D., Hamade, N., Ujueta, F., Scimeca, G., Ortiz-Rios, M. D., McGonagle, B., Galanaud, J. P., Jiménez, D., Monreal, M., Fanikos, J., Dua, A., Tefera, L., Kolluri, R., Parikh, S. A., Ageno, W., Goldhaber, S. Z., Weitz, J. I., Moores, L. K., Quéré, I., … Bikdeli, B. (2025). Superficial Vein Thrombosis: A Review. JAMA, 10.1001/jama.2025.15222. Advance online publication. https://doi.org/10.1001/jama.2025.15222
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