Varicose veins with a painful palpable cord by the ankle—what is the appropriate treatment?

• A. Compression stockings
• B. Oral anticoagulation
• C. Surgery
• D. Subcutaneous enoxaparin

Answer: (D)

Painful, palpable cord along a varicose vein signals superficial thrombophlebitis. The treatment aim is to prevent the clot from extending into the deep venous system and to reduce inflammation and symptoms. Subcutaneous enoxaparin provides rapid, predictable anticoagulation that limits thrombus propagation and lowers the risk of progressing to deep vein thrombosis, which is why it’s chosen here. Compression stockings can help with comfort and swelling but don’t stop clot spread, while oral anticoagulation isn’t typically needed for isolated superficial thrombophlebitis and carries bleeding risk. Surgery is reserved for specific complications or nonresolving cases. If there’s concern for deep vein involvement, duplex ultrasound can assess extent, guiding further management.