Thrombophlebitis

What happens in thrombophlebitis

Veins return blood to the heart. Superficial veins lie just under the skin, while deep veins run through the muscles. In thrombophlebitis, a clot forms in a vein and the vein wall becomes inflamed.

Causes and risk factors

• Varicose veins: the most common setting in the legs
• IV lines and catheters: irritation and clotting at the site, usually in the arm
• Injury to a vein
• Immobility: long trips, bed rest, recent surgery
• Pregnancy and the weeks after birth
• Estrogen-containing birth control or hormone therapy
• Cancer: sometimes causing migratory thrombophlebitis that moves from place to place (Trousseau syndrome)
• Inherited clotting disorders such as factor V Leiden, and acquired ones such as antiphospholipid syndrome
• Previous blood clots
• Obesity and smoking
• Inflammatory conditions such as Behçet disease and Buerger disease
• IV drug use

Symptoms

• a firm, tender, rope-like cord along a vein
• redness and warmth over the vein
• pain, worse when the area is pressed or the leg hangs down
• mild swelling around the vein
• later, a brown discoloration over the vein as it heals

Signs of DVT, such as swelling of the whole calf or leg, suggest deeper involvement.

Diagnosis

• Examination of the vein and leg
• Duplex ultrasound: recommended for most leg thrombophlebitis to measure the clot length, check how close it is to the deep veins (especially the saphenofemoral junction at the groin), and look for DVT
• Blood tests for clotting disorders or cancer screening in unexplained, recurrent or migratory cases

Treatment

Small superficial clots

• warm compresses for 15 to 20 minutes several times a day
• NSAIDs such as ibuprofen, following the label dose, or a topical NSAID gel; avoid NSAIDs with kidney disease, stomach ulcers or on blood thinners
• compression stockings for comfort and swelling
• keep walking: bed rest is not recommended
• elevate the leg when resting

Larger or higher-risk clots

Guidelines recommend a blood thinner, usually for about 45 days, for:

• clots of about 5 cm (2 inches) or longer
• clots close to the junction with the deep veins (within a few centimeters)
• clots above the knee in the great saphenous vein, especially with risk factors

A clot extending into the deep vein at the groin is treated as a DVT.

IV-related and septic thrombophlebitis

• remove the IV catheter
• warm compresses and pain relief
• antibiotics, and sometimes surgery, for septic thrombophlebitis, which involves infection

Treating the cause

• treatment of varicose veins (endovenous ablation or surgery) for recurrent episodes
• review of estrogen-containing medicines
• investigation for cancer or clotting disorders when appropriate

Complications

• extension into deep veins (DVT)
• pulmonary embolism
• infection (cellulitis or septic thrombophlebitis)
• recurrence
• skin discoloration

Prevention

• move regularly on long trips and after surgery
• stay active and maintain a healthy weight
• treat troublesome varicose veins
• change IV sites as recommended in the hospital
• discuss clot risk before starting estrogen if you have a history of clots

Frequently asked questions

What is thrombophlebitis?

Thrombophlebitis is inflammation of a vein caused by a blood clot. It usually affects a superficial vein in the leg, causing a red, warm, tender cord under the skin. Deep vein thrombosis is a related but more serious condition affecting deeper veins.

Is thrombophlebitis dangerous?

Superficial thrombophlebitis is usually not dangerous and settles within a few weeks. However, about 1 in 4 people also have a DVT, and clots near the groin can extend into the deep veins and travel to the lungs. An ultrasound helps assess the risk.

How is thrombophlebitis different from DVT?

Thrombophlebitis usually affects veins just under the skin, causing a visible red, tender cord. DVT affects deep veins inside the muscles, causing swelling and aching of the calf or leg, and carries a higher risk of a clot traveling to the lungs.

How long does thrombophlebitis last?

Pain and redness usually improve within 1 to 2 weeks. The hardness of the vein may take several weeks to settle, and brown skin discoloration can last months. Larger clots treated with blood thinners are usually treated for about 6 weeks.

Should I massage a vein with thrombophlebitis?

No. Massaging a vein with a clot is not recommended. Use warm compresses, anti-inflammatory medicine if suitable, compression and gentle walking instead, and see a doctor to check the size and location of the clot.