Thrombophlebitis

What is Thrombophlebitis?

Thrombophlebitis is an acute condition characterized by inflammation and thrombus formation.It may occur in deep or superficial veins. Thrombophlebitis typically occurs at the valve cusps because venous stasis encourages accumulation and adherence of platelet and fibrin. It usually begins with localized inflammation alone (phlebitis), but such inflammation rapidly provokes thrombus formation. Rarely, venous thrombosis develops without associated inflammation of the vein (phlebothrombosis).

Deep vein thrombophlebitis affects small veins, such as the lesser saphenous vein, or large veins, such as the vena cava and the iliac, femoral, and popliteal veins. It's more serious than superficial vein thrombophlebitis because it affects the veins deep in the leg musculature that carry 90% of the venous outflow from the leg.

The incidence of deep vein thrombophlebitis involving the subclavian vein is increasing with the increased use of subclavian vein catheters. Some hospitalized patients are more at risk than others; however, the risk of developing deep vein thrombophlebitis increases dramatically after age 40.

Superficial vein thrombophlebitis is usually self limiting and, because the superficial veins have fewer valves than the deep veins, is less likely to cause complications

Causes of Thrombophlebitis

Thrombophlebitis may result from infection or injury that prompts excessive clotting in the veins. It can also be caused by sitting for long periods on a plane, resting in bed for a long time, or wearing a cast. This immobility prompts blood to pool and, eventually, clot. Smoking while using birth control pills can also lead to more than the usual amount of clotting. Some cases of thrombophlebitis are a result of injury to the wall of the vein from needles or IV fluids or the spread of blood cancer.

Signs & Symptoms of Thrombophlebitis

Signs and symptoms of thrombophlebitis include:

• Warmth, tenderness and pain in the affected area
• Redness and swelling

When a superficial vein is affected, a red, hard and tender cord may be present just under the surface of your skin. When a deep vein is affected, your leg may become swollen, tender and painful, most noticeably when you stand or walk. You may also have a fever. However, many people with deep vein thrombosis have no symptoms.

Diagnostic Tests

In superficial thrombophlebitis, the location of the clot sometimes can be seen by the unaided eye. Blood clots are hard and can usually be detected by a physician using palpation (touching or massage). Deep venous thrombosis requires specialized diagnostic procedures to detect the blood clot. Among the exams a physician may use are ultrasound and x ray, coupled with dye injection (venogram).

Treatment

In deep vein thrombophlebitis, treatment includes bed rest, with elevation of the affected arm or leg; application of warm, moist compresses to the affected area; and analgesics. After the acute episode subsides, the patient may begin to ambulate while wearing antiembolism stockings (applied before he gets out of bed).

Treatment may include anticoagulants (initially, heparin; later, warfarin) to prolong clotting time. However, the full anticoagulant dose must be discontinued during any surgery to avoid the risk of hemorrhage. After some types of surgery, especially major abdominal or pelvic operations, prophylactic doses of anticoagulants may reduce the risk of deep vein thrombophlebitis.

For lysis of acute, extensive deep vein thrombophlebitis, treatment should include streptokinase or urokinase, if the risk of bleeding doesn't outweigh the potential benefits of thrombolytic treatment.

Therapy for severe superficial vein thrombophlebitis may include an anti-inflammatory drug such as indomethacin along with antiembolism stockings, warm compresses, and elevating the patient's leg.

Prevention Tips

Routine changing of intravenous (IV) lines helps to prevent thrombophlebitis related to IV lines.

If you are taking a long car or plane trip, walk or stretch your legs once in a while and drink plenty of liquids.