title: Treatment for superficial infusion thrombophlebitis of the upper extremity.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Medical, Oral and Biotechnological Sciences, University "G. D'Annunzio" of Chieti-Pescara, via dei Vestini 31, Chieti, Italy, 66013.
authors.forename: Marcello
authors.initials: M
authors.lastname: Di Nisio
authors.forename: Frank
authors.initials: F
authors.lastname: Peinemann
authors.forename: Ettore
authors.initials: E
authors.lastname: Porreca
authors.forename: Anne W S
authors.initials: AW
authors.lastname: Rutjes
mesh_terms: D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D000925:Anticoagulants / Q000008:administration & dosage*; D002406:Catheterization, Peripheral / Q000009:adverse effects*; D017985:Dalteparin / Q000008:administration & dosage; D004008:Diclofenac / Q000008:administration & dosage; D004338:Drug Combinations; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage; D004928:Escin / Q000008:administration & dosage; D005782:Gels / Q000008:administration & dosage; D006493:Heparin / Q000008:administration & dosage; D006496:Heparinoids / Q000008:administration & dosage; D006801:Humans; D007052:Ibuprofen / Q000008:administration & dosage; D005996:Nitroglycerin / Q000008:administration & dosage / Q000031:analogs & derivatives; D010426:Pentosan Sulfuric Polyester / Q000008:administration & dosage; D010743:Phospholipids / Q000008:administration & dosage; D011089:Polydeoxyribonucleotides / Q000008:administration & dosage; D016032:Randomized Controlled Trials as Topic; D013924:Thrombophlebitis / Q000188:drug therapy* / Q000209:etiology; D034941:Upper Extremity
chemical_list: D000893:Anti-Inflammatory Agents; D000925:Anticoagulants; D004338:Drug Combinations; D004365:Drugs, Chinese Herbal; D005782:Gels; D006496:Heparinoids; D010743:Phospholipids; D011089:Polydeoxyribonucleotides; C542919:notoginseny; C046596:Hirudoid; D004008:Diclofenac; D010426:Pentosan Sulfuric Polyester; C036901:defibrotide; C049454:glycerol-1-nitrate; D004928:Escin; C013980:Essaven Gel; D006493:Heparin; D005996:Nitroglycerin; D017985:Dalteparin; D007052:Ibuprofen