Thrombophlebitis
What is it?
Thrombophlebitis is inflammation of a vein (usually in an extremity, especially one of the legs) that occurs in response to a blood clot in the vessel. When it occurs in a vein near the surface of the skin, it is known as superficial thrombophlebitis, a minor disorder commonly identified by a red, tender vein. Deep-vein thrombophlebitis (affecting the larger veins farther below the skin's surface) is more serious. It may produce less-pronounced symptoms at first—indeed, half of all cases are asymptomatic— but carries the risks of pulmonary embolism (when the clot detaches from its place of origin and travels to the lung) and chronic venous insufficiency (impaired outflow of blood through the veins), resulting in dermatitis, increased skin pigmentation, and swelling. Thrombophlebitis is common; incidence is higher among women and older people.
What Causes It?
- Stagnation of blood flow due to immobility. This is common among bedridden patients (such as heart patients and those who have undergone any type of major or orthopedic surgery, especially of the hip or knee) and healthy persons who sit or lie still for an extended period—for example, on a long trip.
- Blood vessel injury, caused by trauma, intravenous catheters or needles, chemotherapeutic agents, or infectious organisms.
- Conditions that increase the tendency for blood to coagulate, such as a familial deficiency in anticlotting factors or disorders like systemic lupus erythematosus.
- Pregnancy and varicose veins are associated with a higher risk of superficial thrombophlebitis.
- Deep-vein thrombophlebitis is associated with a number of different cancers.
Prevention
- Stand up and walk around often on long trips.
- Following a heart attack or major surgery, low doses of an anticoagulant such as heparin or warfarin may be recommended. Frequently walking around again as soon as possible is also advised.
Diagnosis
- Superficial thrombophlebitis can usually be diagnosed from patient history and physical examination alone. Deep-vein thrombophlebitis is more elusive and often requires further tests.
- Venography (x-rays following the injection of a contrast material into the affected vein) is a highly accurate means of identifying an obstructing clot.
- Ultrasound may be used to identify altered blood flow caused by an obstructing clot.
How to Treat It
- Superficial thrombophlebitis may be treated with warm compresses and anti-inflammatory drugs to relieve discomfort, and elevation of the affected limb to reduce swelling. A few days of rest are advised.
- Hospitalization may be required for deep-vein thrombophlebitis. Bed rest and elevation of the affected limb are essential. An anticoagulant, usually heparin, is administered intravenously for seven to 10 days to inhibit further clotting.Oral anticoagulants such as warfarin are then given for three to 12 months depending on the thrombophlebitis site.
- Thrombolytic (clot-dissolving) agents such as streptokinase or urokinase may be administered in some cases to completely resolve the condition.
- Special elastic support stockings may be prescribed to aid circulation in the lower limbs.
- Surgery may be advised to tie off the affected vein to prevent the clot from migrating to the lungs (pulmonary embolism).
When to Call a Doctor
- Call a doctor if you have a painful, swollen vein that does not disappear in a few days, or if you have unexplained swelling in an arm or leg.
For more Johns Hopkins health information, please visit Johns Hopkins Health Alerts.
For medical appointments at Johns Hopkins, please call 866-386-1617.
All information contained within the Johns Hopkins Symptoms and Remedies website is intended for educational purposes only. Consumers should never disregard medical advice or delay in seeking it because of something they may have read on this website.
Copyright © 2008 Medletter Associates, LLC
Content excerpted from Johns Hopkins Symptoms and Remedies: The Complete Home Medical Reference.