Thrombophlebitis

Definition
Thrombophlebitis is inflammation of a vein caused by a blood clot in the vein. (In medical terms, phlebitis is inflammation of a vein and thrombosis is a blood clot.) Superficial thrombophlebitis, which is painful but not life-threatening, develops in small veins close to the skin's surface. Deep thrombophlebitis or deep vein thrombosis (DVT), which may have fatal complications, is found in large veins deep in the body.

Causes/associated factors
Thrombophlebitis is caused by restricted or slowed blood flow in the vein, injury to the vein wall or a blood-clotting problem. The risk of developing thrombophlebitis increases with age. Additional risk factors include:
prolonged bedrest
sitting or standing for long periods of time
recent trauma or surgery, especially hip or knee replacement
having a lower extremity in a cast
varicose veins
taking birth control pills or other forms of estrogen
using intravenous medications or drugs
smoking
obesity
infections or certain medical conditions, such as stroke, heart failure or cancer
pregnancy
being paralyzed
family or personal history of thrombophlebitis
genetic or acquired defects in blood clotting or clot-dissolving proteins

Signs/symptoms
With superficial thrombophlebitis, the vein may feel like a cord. The affected area is usually an extremity -ymptoms or none at all, which can make diagnosis difficult.

Diagnosis
The doctor will ask questions about your medical history and do a physical exam. The blood flow in your vein may be examined through ultrasound (using sound waves to create images of internal body parts). Other tests may include venography (an X-ray taken after dye is injected into the vein) or plethysmography (measuring volume changes of the affected body part). You may also need a chest X-ray, lung scan, spiral CT (a type of computed tomography, a special X-ray test used to produce pictures of internal body parts), pulmonary angiography (an imaging technique for the lungs) or blood tests, such as the d-dimer (a test that measures the level of clotting fragments present in the blood). Magnetic resonance imaging (MRI, an imaging technique based on computer analysis of the body's response to a magnetic field) may be used to detect thrombosis in certain areas, such as the calf of the leg or the pelvis.

Treatment
Superficial thrombophlebitis is often treated with one to two weeks of self-care at home. Your doctor may recommend bedrest until the pain and swelling have subsided. You may need to elevate the affected area, and wear support stockings or leg compression wraps. Warm compresses and anti-inflammatory medications, such as aspirin or ibuprofen, may also be suggested by your doctor to help ease discomfort. You will probably have a repeat evaluation by your doctor one to three days after diagnosis to make sure the condition hasn't worsened. If the area is infected, antibiotics or surgery may be necessary.
Treatment of deep vein thrombosis has traditionally required hospitalization for about a week. You may be given heparin (a blood-thinning medication) through an IV to prevent further blood clots and stabilize clots that have already formed. In some cases, thrombolytics (IV medications that dissolve clots) or surgery to remove the clots are necessary. You'll also be given warfarin, an oral medication used to prevent clots. Warfarin is usually used in combination with heparin until warfarin has reached effective levels in your blood. Then, heparin is discontinued. Warfarin is usually prescribed for three months, but sometimes for up to six months or longer. Blood tests will be done periodically to monitor your bleeding time and make adjustments in your warfarin dosage if necessary. The doctor may also recommend the same self-care tips as described above.

It's now possible in certain situations to treat DVT at home. These patients are carefully selected and given heparin by injection. Warfarin will also be prescribed for three months or longer, as described above. Contact your doctor for details.

Certain people may not be able to take anticoagulants (blood thinners) such as heparin and warfarin. They may be candidates for the surgical placement of a filter in a large vein that would keep blood clots in the leg from traveling to the lungs.


Complications
Superficial thrombophlebitis can lead to vein thrombosis, leg or extremity swelling, or skin changes such as discoloration or ulcers (sores). Cellulitis may also result, which can potentially lead to an infection in the blood.
Complications of DVT may include permanent vein damage with pain, extremity swelling, skin changes and possible leg ulcers. Also, a blood clot may break loose and travel to the lungs. This condition, known as a pulmonary embolism, can be fatal.


Pregnancy-specific information
Again, being pregnant increases the risk of developing thrombophlebitis. An MRI may be a more helpful diagnostic test than ultrasound during the second and third trimesters. Warfarin should not be used during pregnancy, but heparin is considered safe.

Senior-specific information
The risk of developing thrombophlebitis, particularly DVT, increases with age.

Prevention
To help prevent thrombophlebitis:
Don't smoke.

Avoid using intravenous drugs.

Promote circulation with moderate physical activity. (Consult your doctor before beginning an exercise program, however.)

Elevate your feet higher than your hips when sitting for long periods of time. Move your legs at least every one to two hours.

When taking long bus, car or airplane trips, take frequent breaks to stretch and walk. If this is not possible, do seated exercises such as rotating your ankles and flexing your calf muscles every hour to help keep the blood in your legs moving. Consider wearing elastic knee high support hose.

If you're taking birth control pills, use the low estrogen variety if possible. Do not smoke while you're taking oral contraceptives, especially if you're older than age 34.

If you're confined to bedrest, move your legs as much as possible (or as recommended by your doctor) to prevent pooling of blood and blood clots.

After surgery, walk as soon as possible (or as directed by your doctor), use leg compression wraps, and ask your doctor about blood-thinning medication.