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Dr Kesteven and Mr Robinson (April 2001 JRSM, pp. 186-187) suggest that anticoagulation may provide symptomatic relief for acute thrombophlebitis but there is no evidence to support this. Although Hirudoid cream and piroxicam gel appear to be ineffective as analgesics1, non-steroidal anti-inflammatory drugs may be beneficial2. More important is the prevention of extension by the thrombus into the deep veins and hence the risks of pulmonary embolism and post-thrombotic leg syndrome. Early ligation of the affected vein with removal of all phlebitic veins may prevent proximal extension, especially when the thrombus is near the saphenofemoral junction3. Furthermore, this is as effective as long-term anticoagulation in preventing deep venous thrombosis4 and may be considered in those who would otherwise find prolonged anticoagulation treatment and monitoring difficult.