Thrombophlebitis

Thrombophlebitis, a mouthful of a word, simply means a blood clot forming in a vein, slowing down blood flow. It most often affects your legs, but don’t be surprised if it shows up in your arms or elsewhere. While it can be uncomfortable, the good news is that it often resolves on its own. The term “thrombo” refers to a clot, while “phlebitis” indicates inflammation in a vein, often occurring after an injury.

Types of Thrombophlebitis

• Superficial Thrombophlebitis: This is the most common type, affecting veins just below the skin. It’s usually painful and causes redness and swelling in the area. While not as dangerous as other types, it still needs attention.
• Deep Vein Thrombosis (DVT): This is a more serious blood clot that forms deep within a vein. DVTs are dangerous because a clot can break loose and travel to your lungs, potentially causing a life-threatening blockage (pulmonary embolism).
• Migratory Thrombophlebitis: This less frequent type involves clots forming in different veins, often moving from one leg to the other. It’s sometimes linked to certain cancers.

Signs and Symptoms:

• Red, swollen, and irritated skin around the affected area
• Pain or tenderness, especially when applying pressure
• A swollen, hard vein under your skin
• Pain when flexing your ankle (though pain can occur in other parts of the body)
• A swollen foot or ankle

Seek immediate medical attention if you experience:

• Sudden leg pain or swelling
• One leg feels warmer or appears redder, more swollen, or painful than the other
• Chills and fever, along with leg symptoms
• Sudden coughing, possibly with blood
• Sharp chest pain or tightness
• Pain in your shoulder, arm, back, or jaw
• Difficulty breathing or rapid breathing
• Lightheadedness
• Rapid heartbeat

What Causes It?

Thrombophlebitis typically begins with the formation of a blood clot, which can occur due to various factors. Most commonly, it arises from impaired blood flow in the leg veins. This can be attributed to:

1. Prolonged Bed Rest: After a significant illness or surgery, extended periods of immobility can contribute to the development of blood clots.
2. Prolonged Sitting: Sitting for extended periods, such as during long car rides, flights, or in situations where leg movement is restricted, can also hinder blood flow and promote clot formation.
3. Varicose veins: These enlarged and twisted veins can disrupt normal blood flow, leading to the pooling of blood within the vessel and increasing the risk of clot formation.

Who’s at Risk?

Individuals with compromised circulation in their legs are at a heightened risk of developing thrombophlebitis. This includes women who may experience it during or after pregnancy, as well as individuals who have been hospitalized and received intravenous (IV) therapy. Healthcare professionals take precautions to reduce this risk by changing the locations of IV lines regularly.

Other factors that increase the likelihood of thrombophlebitis include:

• Certain types of cancers
• Use of estrogen-containing contraceptives or hormone replacement therapy
• Being over the age of 60
• Obesity
• Smoking
• Family or personal history of blood clots
• Presence of catheters inserted into central veins of the arm or leg
• Hypercoagulable states (conditions that promote excessive blood clotting)
• History of trauma or immobilization due to injury or surgery

Diagnosis

When you visit the doctor with symptoms suggestive of thrombophlebitis, they will begin by conducting a thorough assessment. This typically involves:

1. Physical Examination: The doctor will inquire about your symptoms and examine the veins near the surface of your skin.
2. Blood and Circulation Tests: Your healthcare provider may order blood tests to check for specific markers, such as the D-dimer protein, which is produced when a blood clot breaks down.
3. Imaging Exams: Various imaging tests may be utilized to visualize the affected area and confirm the presence of a clot. These tests include:

• Duplex Ultrasound: This non-invasive imaging technique uses sound waves to create detailed images of your blood vessels. A gel is applied to the skin, and a wand is moved over the area of concern to produce images.
• MR Venography and CT Venography: If the ultrasound results are inconclusive, these imaging studies may be performed. A contrast dye is injected into the veins, and X-ray images are taken to identify the clot. Possible side effects include discomfort and allergic reactions to the dye.
• MR Angiography (MRA): This test provides a detailed picture of the veins using magnetic resonance imaging (MRI). A special dye is injected into the veins to enhance visibility, allowing the doctor to detect any abnormalities.
• CT Scan: If there are concerns that a deep vein clot has migrated to the lungs, a CT scan may be recommended to obtain clearer images.

Treatment

In many cases, thrombophlebitis in superficial veins resolves on its own within a week or two. However, in rare instances, these clots can lead to complications such as infection or tissue damage due to impaired circulation.

If treatment is necessary, your doctor may recommend the following approaches:

1. Pain and Swelling Relief: To alleviate discomfort, your doctor may prescribe medications to reduce swelling and pain. They may also advise elevating your leg or arm and suggest over-the-counter aspirin or ibuprofen. Applying heat to the affected area for 15 to 30 minutes, two to three times a day, can also help.
2. Antibiotics: Poor circulation caused by thrombophlebitis can lead to infection. In such cases, doctors may prescribe antibiotics to fight the infection.
3. Blood Thinners: Doctors often recommend anticoagulant medications (blood thinners) for cases involving deep vein thrombosis (DVT) or a high risk of blood clots traveling to the lungs or brain. These medications, such as heparin, enoxaparin (Lovenox), or warfarin (Coumadin), prevent the clot from enlarging and help prevent future clots. Regular blood tests are necessary to monitor the effectiveness of these medications.
4. Compression Stockings: After the clot has resolved and while on blood thinners, wearing compression stockings on the affected leg can reduce swelling and lower the risk of post-thrombotic syndrome. These stockings work by decreasing pressure in the veins, thereby reducing the risk of varicose veins.
5. IVC Filter: For people at high risk of DVTs and pulmonary embolism who can’t safely take blood thinners, doctors may insert an inferior vena cava (IVC) filter. This device prevents clots from traveling to the lungs by capturing them in the abdomen’s main vein.This treatment requires surgery to place an IVC filter, which is ideally removed within three months.
6. Varicose Vein Stripping: For veins causing pain or recurrent thrombophlebitis, varicose vein stripping may be recommended. This surgical procedure involves making small incisions to remove a long vein, which does not impact circulation. Deeper veins in the body can compensate for the removed vein’s function.

Preventing blood clots

• Get moving! Avoid prolonged sitting, especially during travel. Take breaks to walk around and stretch your legs.
• Stay hydrated by drinking plenty of fluids.
• Avoid tight clothing that restricts circulation.
• If you’re at high risk, talk to your doctor about preventative measures like blood thinners.

Complications

Although rare, thrombophlebitis can lead to serious complications.

1. Pulmonary Embolism: If a clot detaches and travels to the lungs, it can block an artery, causing a pulmonary embolism. This condition is life-threatening and requires immediate medical attention.
2. Postphlebitic Syndrome: This syndrome may develop months or even years after experiencing deep vein thrombosis (DVT). It often manifests as pain, swelling, and a sensation of heaviness in the affected leg or arm. Postphlebitic syndrome is also referred to as post-thrombotic syndrome, venous stasis syndrome, or chronic venous insufficiency.

Remember: Early detection and treatment are key to managing thrombophlebitis. If you experience any concerning symptoms, don’t hesitate to seek medical attention. By being informed and taking precautions, you can keep your blood flowing smoothly and maintain good health.pen_sparktunesharemore_vert

Sources

1. Mayo Clinic: “Thrombophlebitis,” “Thrombophlebitis: Tests and Diagnosis.”
2. MedlinePlus: “Deep venous thrombosis.”
3. Medscape: “Superficial Thrombophlebitis Clinical Presentation.”
4. Cleveland Clinic: “Superficial Thrombophlebitis.”
5. Webmd: Thrombophlebitis
6. NIH National Heart, Lung, and Blood Institute: “What Is Deep Vein Thrombosis?”
7. UpToDate: “Phlebitis and thrombosis of the superficial lower extremity veins.”
8. Johns Hopkins Medicine: “Thrombophlebitis.”