Diagnosis

To diagnose thrombophlebitis, your doctor will ask you about your discomfort and look for affected veins near your skin's surface. To determine whether you have superficial thrombophlebitis or deep vein thrombosis, your doctor might choose one of these tests:

  • Ultrasound. A wandlike 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.

  • This test can confirm the diagnosis and distinguish between superficial and deep vein thrombosis.

  • 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. So a test for D dimer isn't conclusive, but can indicate the need for further testing.

  • It's also useful for ruling out DVT and for identifying people at risk of developing thrombophlebitis repeatedly.

Treatment

For superficial thrombophlebitis, your doctor might recommend applying heat to the painful area, elevating the affected leg, using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) and possibly wearing compression stockings. The condition usually improves on its own.

Your doctor might also recommend these treatments for both types of thrombophlebitis:

  • 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, Jantoven, others) or the newer rivaroxaban (Xarelto) for several months continues to prevent clots from enlarging.

  • If your doctor prescribes a blood thinner, follow directions carefully. Their most serious side effect can be excessive bleeding.

  • Clot-dissolving medications. Treatment with medications such as alteplase (Activase) dissolves blood clots. Also known as thrombolysis, this treatment is used for extensive DVT, including some cases that involve a blood clot in the lungs (pulmonary embolus).
  • Compression stockings. Prescription-strength compression stockings help prevent swelling and reduce the chances of complications of DVT.
  • Filter. In some instances, especially if you can't take blood thinners, a filter can 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. Usually, 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 this procedure. It 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.

Lifestyle and home remedies

In addition to medical treatments, here are self-care measures 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

Let your doctor know if you're taking another blood thinner, such as aspirin.

Preparing for your appointment

If you have signs or 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 signs and 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 to help you get ready.

What you can do

Make a list of:

  • Your symptoms, including any that may seem unrelated to the reason for your appointment
  • Key personal information, including a family history of blood-clotting disorders or long periods of inactivity recently, such as a car or plane trip
  • All medications, vitamins or other supplements you take
  • Questions to ask your doctor

Have someone take you to your doctor or emergency room, if possible. It might be difficult for you to drive, and it's helpful to have someone with you to help you remember the information you receive.

For thrombophlebitis, basic questions to ask your doctor include:

  • What is likely causing my condition?
  • What are other possible causes?
  • What tests do I need?
  • What treatments are available and which do you recommend?
  • I have other health conditions. How can I best manage these conditions together?
  • Are there dietary or activity restrictions I need to follow?
  • Are there brochures or other printed material I can have? What websites do you recommend?

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did your symptoms begin?
  • Do you have symptoms all the time, or do they come and go?
  • How severe are your symptoms?
  • Have you had an injury or surgery within the past three months?
  • What, if anything, seems to improve or worsen your symptoms?
Nov. 30, 2016
References
  1. Nasr H, et al. Superficial thrombophlebitis (superficial venous thrombosis). British Medical Journal. 2015;350:u2039.
  2. Scovell S, et al. Phlebitis and thrombosis of the superficial lower extremity veins. http://www.uptodate.com/home. Accessed July 11, 2016.
  3. Bauer KA. Approach to the diagnosis and therapy of a lower extremity deep vein thrombosis. http://www.uptodate.com/home. Accessed July 11, 2016.
  4. Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg (review). Cochrane Database of Systemic Reviews. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004982.pub5/abstract. Accessed July 11, 2016.
  5. Deep vein thrombosis. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/health-topics/topics/dvt#. Accessed July 11, 2016.
  6. Alguire PC, et al. Post-thrombotic (postphlebitic) syndrome. http://www.uptodate.com/home. Accessed July 11, 2016.