A 40-year-old woman presents with superficial thrombophlebitis of the great saphenous vein (GSV) extending to within 3 cm of the saphenofemoral junction (SFJ). The current ACCP/ESC recommended treatment is:

• A Low-molecular-weight heparin at prophylactic dose for 4 weeks
• B Urgent ligation and stripping of GSV
• C Rivaroxaban 15 mg twice daily for 3 months
• D Fondaparinux 2.5 mg/day subcutaneously for 45 days ✓

Explanation

For superficial venous thrombosis involving the GSV close to the SFJ (within 3 cm), there is significant risk of extension into the deep venous system. The CALISTO trial established fondaparinux 2.5 mg subcutaneously for 45 days as the standard treatment, reducing extension to DVT/PE by 85% compared to placebo. This is now a grade 1B recommendation. Prophylactic-dose LMWH is less effective; rivaroxaban is not approved for this specific indication; urgent surgical ligation is an older approach largely replaced by anticoagulation.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.