Thrombophlebitis (throm-boe-fluh-BY-tis) occurs when a blood clot blocks one or more of your veins, typically in your legs. Rarely, thrombophlebitis (sometimes called phlebitis) can affect veins in your arms or neck.
The affected vein may be near the surface of your skin, causing superficial thrombophlebitis, or deep within a muscle, causing deep vein thrombosis (DVT). Thrombophlebitis can be caused by trauma, surgery or prolonged inactivity. Superficial thrombophlebitis may occur in people with varicose veins.
A clot in a deep vein increases your risk of serious health problems, including the possibility of a dislodged clot (embolus) traveling to your lungs and blocking an artery there (pulmonary embolism). Deep vein thrombosis is usually treated with blood-thinning medications. Superficial thrombophlebitis is sometimes treated with blood-thinning medications, too.
Superficial thrombophlebitis symptoms include:
- Warmth, tenderness and pain in the affected area
- Redness and swelling
Deep vein thrombosis symptoms include:
When a vein close to the surface of your skin is affected, you may see a red, hard and tender cord just under the surface of your skin. When a deep vein in the leg is affected, your leg may become swollen, tender and painful.
When to see a doctor
See your doctor right away if you have a red, swollen or tender vein — especially if you have one or more risk factors for thrombophlebitis. If you have leg swelling and pain along with shortness of breath or chest pain that hurts when you take a deep breath, go to an emergency room. These signs and symptoms may indicate deep vein thrombosis, which increases your risk of a dislodged blood clot traveling through your veins to your lungs.
The cause of thrombophlebitis is a blood clot. Blood clots can be caused by many different things — namely anything that causes your blood not to circulate properly. It's possible a blood clot that causes thrombophlebitis could be caused by:
- An injury to a vein
- An inherited blood-clotting disorder
- Being immobile for long periods of time, such as during a hospital stay
Your risk of thrombophlebitis increases if you:
- Are confined to bed for a prolonged time, such as after surgery, after a heart attack or after an injury, such as breaking your leg
- Have had a stroke that caused your arms or legs to be paralyzed
- Have a pacemaker or have a thin, flexible tube (catheter) in a central vein, for treatment of a medical condition, which may irritate the blood vessel wall and decrease blood flow
- Are pregnant or have just given birth, which may mean you have increased pressure in the veins of your pelvis and legs
- Use birth control pills or hormone replacement therapy, which may make your blood more likely to clot
- Have a family history of a blood-clotting disorder or a tendency to form blood clots easily
- Are inactive for a long period of time, such as from sitting in a car or an airplane
- Are older than 60
- Have varicose veins, which are a common cause of superficial thrombophlebitis
The more risk factors you have, the higher your risk of thrombophlebitis. If you have one or more risk factors, be sure to discuss prevention strategies with your doctor before long periods of inactivity, such as after an elective surgery or during a long flight or car ride.
If thrombophlebitis is in a vein just under your skin (superficial vein), complications are rare. However, if the clot occurs in a deep vein you may develop a serious medical condition known as deep vein thrombosis. If that happens, the risk of serious complications is greater. Complications may include:
- Pulmonary embolism. If part of a deep vein clot becomes dislodged, it may travel to your lungs, where it can block an artery (embolism) and cause a potentially life-threatening situation.
- Post-phlebetic syndrome. This condition, also known as post-thrombotic syndrome, can develop months or even years after you've had deep vein thrombosis. Post-phlebetic syndrome can cause lasting and possibly disabling pain, swelling and a feeling of heaviness in the affected leg. The use of compression stockings for two years or longer after deep vein thrombosis can help prevent or treat this condition.
Deep vein thrombosis also may damage valves in the veins in your legs. Veins have valves to prevent blood from flowing back as it is gradually pushed uphill toward your heart. When the valves in the veins of your legs don't work properly, several problems can occur:
- Varicose veins. The pooling of blood in your veins can cause them to balloon, resulting in varicose veins.
- Swelling. In some cases, the pooling may become so bad that your leg swells (edema).
- Skin discoloration. With chronic swelling and increased pressure on your skin, discoloration may occur. Sometimes, skin ulcers may develop. If you suspect a skin ulcer is forming, call your doctor.
If you have symptoms of thrombophlebitis, such as a red, swollen or tender vein, see your doctor right away. If the vein swelling and pain are severe or you have other symptoms that might indicate a blood clot traveling to your lungs, such as shortness of breath or coughing up blood, call 911 or your local emergency number.
If you have time before your appointment, here's some information that may help you get ready for your appointment, and what to expect from your doctor.
What you can do
- Write down any symptoms you're experiencing, including any that may seem unrelated to thrombophlebitis.
- Write down key personal information, especially if you have a family history of blood-clotting disorders, or if you've been inactive for long periods of time recently, such as traveling by car or plane. Also, if you're planning to travel and are concerned about your thrombophlebitis risk, tell your doctor about your travel plans.
- Make a list of all medications, vitamins and supplements that you're taking.
- Have someone take you to the doctor or emergency room, if possible. It may be difficult for you to drive, and it's helpful to have someone with you at your appointment to help you remember everything your doctor tells you. If you have symptoms of a pulmonary embolism, such as chest pain or shortness of breath, call 911 or your local emergency number for immediate assistance.
- Write down questions to ask your doctor.
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For thrombophlebitis, some basic questions to ask your doctor include:
- What is likely causing my condition?
- What are other possible causes for my symptoms?
- What kinds of tests will I need?
- What treatments are available and which do you recommend?
- What's an appropriate level of physical activity for me now that I've been diagnosed with thrombophlebitis? What about once my clot is gone?
- What are the alternatives to the primary approach that you're suggesting?
- I have other health conditions. How can I best manage these conditions together?
- Are there any dietary restrictions that I need to follow?
- Is there a generic alternative to the medicine you're prescribing?
- What side effects can I expect with this medication?
- Are there any brochures or other printed material that I can take home with me? What websites do you recommend visiting?
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:
- When did you begin experiencing symptoms?
- Do you have symptoms all the time, or do they come and go?
- How severe are your symptoms?
- What other medical conditions do you have?
- Have you had any major injury or surgery within the past three months?
- Have you ever had a pregnancy miscarriage?
- What medications are you currently taking?
- What, if anything, seems to improve or worsen your symptoms?
- Do you have a family history of health problems related to blood clots?
What you can do in the meantime
Before your doctor appointment, you can begin some self-care measures. You can use a warm washcloth as a compress on the affected area, and elevate the affected leg to help with any discomfort. If you decide to take a pain reliever, such as ibuprofen (Advil, Motrin IB, others), be sure to tell your doctor. Medications can interact with other blood clot-dissolving medications your doctor prescribes.
To diagnose thrombophlebitis, your doctor will ask you about the discomfort you've had and then look for any affected veins near the surface of your skin. To determine whether you have superficial thrombophlebitis or deep vein thrombosis, your doctor may choose one of these tests:
- Blood test. Almost everyone with a blood clot has an elevated blood level of a naturally occurring, clot-dissolving substance called D dimer. But D dimer levels can be elevated in other conditions, too. So a test for D dimer isn't conclusive, but may indicate the need for further testing. It's also useful for ruling out deep vein thrombosis and for identifying people at risk of developing thrombophlebitis repeatedly.
- Ultrasound. A wand-like device (transducer) moved over the affected area of your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen. A clot may be visible in the image.
- CT scan. Computerized tomography (CT) scan can provide visual images of your lungs and may show if a clot is present.
If thrombophlebitis occurs in a vein just under your skin, your doctor may recommend self-care steps that include applying heat to the painful area, elevating the affected leg and using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The condition usually doesn't require hospitalization and improves significantly within a month.
Your doctor may also recommend these treatments for thrombophlebitis, including deep vein thrombosis:
- Blood-thinning medications. If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as low molecular weight heparin or fondaparinux (Arixtra), will prevent clots from enlarging. After the initial treatment, taking the oral anticoagulant warfarin (Coumadin) for several months continues to prevent clots from enlarging. If your doctor prescribes warfarin, follow the directions for taking the medication carefully. Warfarin's most serious side effect can be excessive bleeding. Rivaroxaban (Xarelto) is a newer blood-thinning option that is taken orally and may have less risk of bleeding.
- Clot-dissolving medications. This type of treatment is known as thrombolysis. These medications, such as alteplase (Activase), dissolve blood clots and are used for extensive deep vein thrombosis or in some cases of deep vein thrombosis that also include a blood clot in the lungs (pulmonary embolus).
- Compression stockings. Prescription-strength compression stockings help prevent recurrent swelling and reduce the chances of complications of deep vein thrombosis. Your doctor may recommend that you wear these for two years or more.
- Filter. In some instances, especially if you can't take blood thinners, a filter may be inserted into the main vein in your abdomen (vena cava) to prevent clots that break loose in leg veins from lodging in your lungs. Typically, the filter is removed when it's no longer needed. If you have a filter placed, ask your doctor if and when it should be removed.
- Varicose vein stripping. Your doctor can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping. This procedure involves removing a long vein through small incisions. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the increased volumes of blood. This procedure may also be done for cosmetic reasons. After vein stripping, your doctor may recommend that you wear compression stockings as well.
In addition to medical treatments, there are some self-care measures you can take to help improve thrombophlebitis.
If you have superficial thrombophlebitis:
- Use a warm washcloth to apply heat to the involved area several times daily
- Elevate your leg
- Use a nonsteroidal anti-inflammatory drug, such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), if recommended by your doctor
If you have deep vein thrombosis:
- Take prescription anticoagulant medications as directed to prevent complications
- Elevate your leg if it's swollen
- Wear your prescription compression stockings as directed
If you're taking warfarin, ask your doctor if you need to alter your diet. Foods high in vitamin K, such as leafy green vegetables and canola oil, can affect the way this medication works.
Aspirin isn't recommended for people taking warfarin (Coumadin) because it could thin your blood too much. Let your doctor know if you're already taking aspirin for another reason.
Sitting during a long flight or car ride can cause swollen ankles and calves. The inactivity also increases your risk of thrombophlebitis in the veins of your legs. To help prevent a blood clot from forming:
- Take a walk. If you're flying, walk around the airplane cabin once an hour or so. If you're driving, stop every hour or so and walk around.
- If you must stay seated, move your legs regularly. Flex your ankles, or carefully press your feet against the floor or footrest in front of you at least 10 times each hour.
On flights or for car rides lasting more than four hours, take additional precautions to reduce your risk of deep vein thrombosis:
- Avoid wearing tight clothing.
- Drink plenty of nonalcoholic fluids to avoid dehydration.
- Stretch your calves by walking at least once an hour.
If you're at increased risk of deep vein thrombosis, talk to your doctor before your flight. He or she may recommend that you use:
- Compression stockings
- Any prescribed blood-thinning medication as directed
Feb. 22, 2014
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