Definition

Thrombophlebitis is an inflammatory process that causes a blood clot to block one or more veins. It typically occurs in the veins of the legs. The inflamed vein may be near the surface of the skin (superficial thrombophlebitis) or deep within a muscle (deep vein thrombosis or DVT).

The causes of thrombophlebitis include trauma or injury, surgery, or prolonged periods of immobility. DVT increases the risk of serious health issues and is often treated with blood-thinning medications. Superficial thrombophlebitis may also be treated with blood thinners.

Causes

Thrombophlebitis is caused by a blood clot forming in a vein. These blood clots occur due to:

• Injury to a vein
• Blood-clotting disorders, such as inherited hemophilia
• Prolonged immobility, such as during hospitalization or after injury

Risk Factor

Your risk of developing thrombophlebitis increases if:

• You remain inactive for long periods, either from bed rest or long car or plane trips
• You have varicose veins, which are a common cause of superficial thrombophlebitis
• You have a pacemaker or central venous catheter, which can irritate vein walls and slow blood flow
• You are pregnant or have recently given birth
• You are using birth control pills or hormone replacement therapy, which can increase the risk of clotting
• You have a family history of blood clotting disorders
• You have had thrombophlebitis before
• You have had a stroke
• You are over 60 years old
• You are overweight or obese
• You have cancer
• You smoke

If you have one or more of these risk factors, talk to your doctor about preventive strategies, especially if you are planning long travel or undergoing surgery that will require prolonged recovery.

Symptoms

Symptoms of superficial thrombophlebitis include:

• Warmth, tenderness, and pain in the affected area
• Redness and swelling

Symptoms of deep vein thrombosis (DVT) include:

• Pain
• Swelling

If a superficial vein is affected, you might see a red, cord-like structure under the skin that feels tender to the touch.

Diagnosis

To diagnose thrombophlebitis, your doctor will ask about symptoms and perform a physical examination to check for veins near the skin's surface. To determine whether it is superficial thrombophlebitis or DVT, one or more of the following tests may be used:

• Ultrasound: This test uses sound waves to capture images of the body and can distinguish between superficial thrombophlebitis and DVT.
• Blood test: People with blood clots often have elevated levels of D-dimer, a natural substance that dissolves clots. However, D-dimer can be high in other conditions, so this test is used alongside others to rule out DVT and assess the risk of recurrent thrombophlebitis.

Management

For superficial thrombophlebitis, your doctor may suggest warm compresses, elevating the affected leg, taking over-the-counter anti-inflammatory drugs, or wearing compression stockings. The condition typically improves on its own.

For both types of thrombophlebitis, doctors may recommend:

• Blood thinners: For DVT, injections of blood thinners like low-molecular-weight heparin, fondaparinux, or apixaban can prevent clots from growing. After initial treatment, oral medications like warfarin or rivaroxaban may be prescribed for several months to prevent new clots. Blood thinners can increase the risk of excessive bleeding, so follow your doctor’s instructions closely.
• Clot-dissolving drugs: Thrombolysis, a treatment using clot-busting drugs like alteplase, is used for extensive DVT, particularly when clots have reached the lungs (pulmonary embolism).
• Compression stockings: These can prevent swelling and reduce the risk of DVT complications.
• Vena cava filter: If blood thinners are not suitable, a filter may be placed in the vena cava (the main abdominal vein) to prevent clots from traveling to the lungs. The filter is usually removed when it is no longer needed.
• Varicose vein removal: If painful varicose veins cause recurrent thrombophlebitis, surgery may be recommended to remove the affected veins. Deeper veins will take over blood flow to the heart.

For superficial thrombophlebitis, the following home care steps may help:

• Apply warm compresses to the affected area several times a day.
• Keep the leg elevated while sitting or lying down.
• Use non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen sodium, if recommended by your doctor.
• Inform your doctor if you are already taking blood thinners like aspirin.

Tell your doctor if you are taking any other blood coagulants, such as aspirin. If you have deep vein thrombosis, follow these steps:

• Take blood thinners as prescribed by your doctor to prevent complications.
• Keep the leg elevated when sitting or lying down if it is swollen.
• Wear compression stockings as recommended by your doctor.

Complications

Complications of superficial thrombophlebitis are rare, but DVT can lead to serious problems such as:

• Pulmonary embolism: If part of a DVT clot breaks loose, it can travel to the lungs and block an artery, which can be life-threatening.
• Chronic leg pain and swelling (post-phlebitic syndrome): This may occur months or years after a DVT and can significantly affect quality of life.

Prevention

To reduce the risk of blood clots during long flights or car trips, try the following:

• Get up and walk around periodically. If on a plane, train, or bus, walk up and down the aisle at least once an hour. If driving, stop every hour or so and stretch your legs.
• Move your feet regularly. Flex your ankles and press your feet against the floor or a wall in front of you at least 10 times each hour.
• Drink plenty of water and avoid alcohol to stay hydrated.

When to See a Doctor? 

See a doctor if you experience redness, swelling, or pain in your legs, especially if you have risk factors for thrombophlebitis.

Call emergency services or visit the ER if:

• You have severe swelling or pain in a vein.
• You experience shortness of breath, chest pain, coughing up blood, or other symptoms suggesting a blood clot has traveled to your lungs (pulmonary embolism).

Have someone drive you to the doctor or emergency room if possible, as it may be difficult for you to drive yourself.

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