Thrombophlebitis

Description

The thrombophlebitis is a condition that causes a blood clot to form and block one or more veins, usually in the legs. In the superficial thrombophlebitis, the vein is near the surface of the skin. In the deep vein thrombosis, or DVT, the vein is deep within a muscle. Deep venous thrombosis increases the risk of serious health problems. Both types of thrombophlebitis can be treated with blood-thinning medications.

Thrombophlebitis (throm-boe-fluh-BY-tis) is an inflammatory process that causes a blood clot to form and block one or more veins, usually in the legs. The affected vein might be near the surface of the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis, or DVT).

Causes of thrombophlebitis include trauma, surgery, or in case of prolonged inactivity.

Deep vein thrombosis (DVT) increases the risk of serious health problems. It is usually treated with blood-thinning medications. Superficial thrombophlebitis is sometimes treated with blood-thinning medications, also.

Symptoms

The symptoms of superficial thrombophlebitis include heat, tenderness, and pain. You could have redness and swelling, and in red, hard cable just below the surface of the skin which is sensitive to touch. Symptoms of dvt include swelling, tenderness, and pain in the leg.

Superficial thrombophlebitis of the signs and symptoms include:

  • The warmth, the tenderness, and pain in the affected area
  • The redness and swelling

Deep vein thrombosis signs and symptoms include:

  • The pain
  • Swelling

When a vein near the surface of the skin is affected, you may see a red, hard cable just below the surface of the skin which is sensitive to touch. When a deep vein of the affected leg, the legs may become swollen, tender and painful.

When to see a doctor

See your doctor right away if you have a red, tenderness, or swelling of the vein — especially if you have one or more risk factors for thrombophlebitis.

Call 911 or the local emergency number if:

  • The swelling of the veins and the pain are severe
  • You also have shortness of breath or chest pain, coughing of blood, or have other symptoms that may indicate a blood clot that travels to the lungs (pulmonary embolism)

Have someone take you to your doctor or emergency room, if possible. It might be difficult for you to handle, and it is useful to have someone with you to help you remember the information that you receive.

Causes

The thrombophlebitis is caused by a blood clot. A blood clot can form due to an injury to a vein or to have a hereditary disorder that affects the way your blood clots. You can also get a blood clot after not being active for long periods of time, such as during a hospital stay or recovery from an injury.

The cause of thrombophlebitis is a blood clot that can form in blood as a result of:

  • An injury to a vein
  • Hereditary coagulation of the blood
  • Being immobile for long periods of time, such as an injury or a stay in the hospital

Risk factors

The risk of thrombophlebitis is higher if you are not active for a long period or you have a catheter in a central vein to treat a condition. Have varicose veins or a pacemaker may also increase your risk. Women who are pregnant, have given birth, or taking birth control pills or hormone replacement therapy may also be at greater risk. Other risk factors include a family history of blood clotting disorders, a tendency to form blood clots, and have thrombophlebitis before. The risk may also be greater if you have had a stroke, you have more than 60 years of age, or are overweight. The fact of having cancer and smoking are also risk factors.

The risk of thrombophlebitis may increase if:

  • Have been inactive for an extended period of time, either because you are confined to bed, or you're traveling in a car or an airplane during a long period
  • You have varicose veins, which are a common cause of superficial thrombophlebitis
  • Has a pacemaker, or have a thin, flexible tube (catheter) into a central vein, for the treatment of a medical condition, which can irritate the wall of the blood vessels and decrease blood flow
  • Are pregnant or have just given birth
  • The use of birth control pills or hormone replacement therapy, which can make the blood more likely to clot
  • Have a family history of blood clotting disorders or a tendency to form blood clots
  • Have had previous episodes of thrombophlebitis
  • Have had a stroke
  • Are older than 60 years
  • Are overweight or obese
  • You have cancer
  • Smoke

If you have one or more risk factors, discuss prevention strategies with your doctor before taking long flights or road trips, or if you're planning to have an elective surgery, the recovery of which will require you to not move a lot.

Complications

The complications of superficial thrombophlebitis are rare. However, if you develop deep vein thrombosis (DVT), the risk of serious complications increases. Complications can include:

  • Blood clot in the lungs (pulmonary embolism). If part of a deep vein clot is dislodged, it can travel to the lungs, where it can block an artery (stroke), and potentially deadly.
  • Duration of leg pain and swelling (post-phlebetic syndrome). This disease, also known as post-thrombotic syndrome, can develop months or years after having DVT . The pain may be disabling.

Prevention

Sitting during a long flight or car ride can cause your ankles and lower legs to swell and increases the risk of thrombophlebitis. To help prevent a blood clot:

  • Take a walk. If you're flying or riding in a train or a bus, walking up and down the aisle once an hour or so. If you're driving, stop every hour or so and move around.
  • Move the legs on a regular basis. Flex the ankles, or carefully press your feet against the floor or footrest in front of you at least 10 times every hour.
  • Drink plenty of water or other nonalcoholic fluids to avoid dehydration.

Thrombophlebitis

Diagnosis

To diagnose the presence of thrombophlebitis, a doctor may ask about your discomfort and find the affected veins near the surface of the skin. You may have an imaging test, such as an ultrasound, to check his leg, superficial or deep vein thrombosis. A blood test can show if you have a high level of a substance that dissolves clots. This test can also rule out DVT, and show if you are at risk for thrombophlebitis in repeatedly.

To diagnose the presence of thrombophlebitis, your doctor will ask you about your discomfort and find the affected veins near the surface of the skin. To determine if you have superficial thrombophlebitis or deep vein thrombosis, your doctor may choose one of these tests:

  • Ultrasound.A wandlike device (transducer) is moved over the affected area of your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect, a team that transforms the waves into a moving image on a video screen. This test can confirm the diagnosis and to distinguish between superficial and deep venous thrombosis.
  • Blood test.Almost all of the world with a clot of blood has an elevated blood level of a natural, clot-dissolving substance called D-dimer. But D-dimer levels can be elevated in other conditions. So a test of D-dimer is not conclusive, but may indicate the need for further testing. It is also useful to rule out deep vein thrombosis (DVT) and for the identification of persons at risk of developing thrombophlebitis repeatedly.

Ultrasound. A wandlike device (transducer) is moved over the affected area of your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect, a team that transforms the waves into a moving image on a video screen.

This test can confirm the diagnosis and to distinguish between superficial and deep venous thrombosis.

Blood test. Almost all of the world with a clot of blood has an elevated blood level of a natural, clot-dissolving substance called D-dimer. But D-dimer levels can be elevated in other conditions. So a test of D-dimer is not conclusive, but may indicate the need for further testing.

It is also useful to rule out deep vein thrombosis (DVT) and for the identification of persons at risk of developing thrombophlebitis repeatedly.

Treatment

Superficial thrombophlebitis can be treated by the application of heat in the area of pain and elevating the leg. You can also take medication to relieve the swelling and irritation, and wearing compression stockings. From there, it usually improves on its own. Of superficial and deep vein thrombosis, or DVT, you can take medications that thin the blood and break up the clots. You can wear compression stockings, which are available with prescription to prevent inflammation and to prevent the complications of deep vein thrombosis. If you can't take blood thinners, a filter can be placed in the main vein in your abdomen to keep clots lodging in your lungs. Sometimes varicose veins are removed with surgery.

For superficial thrombophlebitis, your doctor may recommend the application of heat to the painful area, elevation of the affected leg, using an over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDS) and, possibly, use of compression stockings. The condition usually improves on its own.

Your doctor also may recommend these treatments for both types of thrombophlebitis:

  • Blood-thinning medications. If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medications, such as low molecular weight heparin, fondaparinux (Arixtra), or apixaban (Eliquis), may help to prevent blood clots from getting bigger. After the first treatment, the more likely it is that you take warfarin (Jantoven) or rivaroxaban (Xarelto) for several months to keep the clot prevention of growth. Blood thinners can cause excessive bleeding. Always follow your doctor's instructions carefully.
  • Clot-dissolving medications. The treatment with clot-busting drugs is called thrombolysis. The drug alteplase (Activase) is used to dissolve blood clots in people with DVT extensive , including those who have a blood clot in the lungs (pulmonary embolism).
  • Compression stockings. Prescription-strength compression stockings help to prevent swelling and reduce the chances of complications of deep venous thrombosis .
  • Vena cava filter. If you can't take blood thinners, a filter can be inserted into the main vein in your abdomen (inferior vena cava) to prevent clots that break free, in the veins of the legs of accommodation in your lungs. Normally, the filter is removed when no longer needed.
  • Removal of varicose veins. A surgeon can remove the varicose veins that cause pain or recurrent thrombophlebitis. The procedure involves the removal of a long vein through small incisions. Extraction of the vein as not to affect the flow of blood in your leg because veins deeper in the leg take care of the increased volume of blood.

Self-care

In addition to medical treatments, self-care measures can help to improve the thrombophlebitis.

If you have superficial thrombophlebitis:

  • Use a warm washcloth to apply heat to the affected area several times a day
  • Keep the leg elevated when sitting or lying down
  • The use of a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), if recommended by your doctor

Tell your doctor if you are taking another blood thinner, such as aspirin.

If you have deep vein thrombosis:

  • Take prescription blood-thinning medications, as directed to prevent complications
  • Keep the leg elevated when sitting or lying down if it is swollen
  • The wear and tear of their prescription-strength compression stockings as shown

Preparing for your appointment

If you have time before your appointment, here's some information to help you prepare.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for your appointment
  • Key personal information, including a family history of blood-clotting disorders or long periods of inactivity recently, such as a car or plane trip
  • All medications, vitamins or other supplements that you take
  • Questions to ask your doctor

For thrombophlebitis, basic questions to ask your doctor include:

  • What is probably the cause of my problem?
  • What are other possible causes?
  • What tests do I need?
  • What treatments are available and which do you recommend?
  • I have other health conditions. How can I best manage these conditions?
  • No dietary or activity restrictions I need to follow?
  • Are there brochures or other printed material I can have? What sites do you recommend?

What to expect from your doctor

Your doctor may ask you questions, such as:

  • When did your symptoms begin?
  • Do you have symptoms all the time, or come and go?
  • How severe are the symptoms?
  • You have had an injury or surgery in the last three months?
  • What, if anything, seems to improve or worsen your symptoms?
Symptoms and treatment of Thrombophlebitis