A 46-year-old male presents for a new diagnosis of a superficial vein thrombosis. The patient has no medical history and is very active. No personal or family history of blood clots. He is up to date with his cancer cancer screening including having a negative colonoscopy and a normal PSA last year. He took a plane flight to China as part of a business trip. When he returned to the United States, he developed swelling of his right leg. An ultrasound of the leg is performed that reveals an SVT that measures 7 cm in size and it is located 2 cm away from the saphenofemoral junction. He is very concerned about developing a DVT given that he travels a lot for his work. In addition to supportive care what should be recommended?
Regarding acute management - given the size and proximity of the thrombus, I would anticoagulate the superficial phlebitis with a course of 6-12 weeks. As for future risk of recurrence, there is very little data to guide practice. In someone with travel-DVT, for future provoking factors such as long trips (>6 hours), I would also temporarily anticoagulate 4 hours before the trip (once or twice) until arrival, assuming no bleeding risk. Only studied with LMWH but I think DOAC is OK. In his case, since it is not really a DVT, I would still err on the side of caution if benefit outweighs risk as this one was an "almost" DVT.
