What is the treatment for phlebitis?

From the Guidelines

Phlebitis treatment should prioritize anticoagulation for at least 3 months, with consideration of catheter removal if symptoms persist or if the catheter is infected or dysfunctional. The treatment approach for phlebitis, particularly in the context of catheter-related deep vein thrombosis (DVT), involves a multifaceted strategy 1.

Diagnosis and Treatment Considerations

• For clinical suspicion of catheter-related DVT, diagnosis involves venous ultrasound, CT venography with contrast, MR venography with contrast, or X-ray venogram with contrast 1.
• Treatment includes anticoagulation for at least 3 months or as long as the central venous access device (CVAD) is in place 1.
• Catheter removal should be considered if symptoms persist, or if the catheter is infected, dysfunctional, or no longer necessary 1.
• Catheter-directed therapy, such as pharmacomechanical thrombolysis or mechanical thrombectomy, may be considered in appropriate candidates, especially those at risk of limb loss, with central thrombus propagation despite anticoagulation, or those with moderate to severely symptomatic proximal DVT 1.

Anticoagulation Management

• The choice of anticoagulant regimen should be based on institutional expertise and preferences, in conjunction with interventional radiology or vascular surgery colleagues 1.
• Anticoagulation without catheter removal is the preferred initial treatment for patients with symptomatic DVT, provided the catheter is necessary, functional, and free of infection 1.
• The duration of anticoagulation depends on tolerance, response to anticoagulation, and catheter status, with consideration for longer duration in patients with catheters having poor flow, persistent symptoms, or unresolved thrombus 1.

Key Considerations

• The primary goal of phlebitis treatment is to reduce inflammation, prevent clot extension, and minimize the risk of complications.
• Treatment strategies must be tailored to the individual patient, considering the severity of symptoms, the presence of a CVAD, and the risk of anticoagulant therapy 1.
• Regular follow-up and monitoring are crucial to adjust treatment as necessary and to prevent potential complications 1.

From the Research

Treatment for Phlebitis

The treatment for phlebitis, particularly deep vein thrombosis (DVT), typically involves anticoagulation therapy to prevent the extension of thrombi, pulmonary embolism, recurrence of thrombi, and the development of complications such as pulmonary hypertension and post-thrombotic syndrome 2.

• Anticoagulant Therapy: Low-molecular-weight heparin, unfractionated heparin, and vitamin K antagonists have been the mainstay of treatment for DVT 3, 2.
• New Oral Anticoagulants: Direct-acting oral anticoagulants like dabigatran, rivaroxaban, and apixaban are also recommended for prophylaxis and treatment 3, 2.
• Thrombolytic Therapy: This is considered in special circumstances, such as hemodynamically unstable patients with a low bleeding risk 3, or for patients with acute iliocaval DVT who are at an increased risk for pulmonary embolism despite adequate anticoagulation 4.
• Catheter-Directed Interventions: Pharmacomechanical catheter-directed thrombolysis is a minimally invasive endovascular therapy that focuses on rapid thrombus removal while decreasing the rate of bleeding complications associated with systemic therapy 4, 5.
• Inferior Vena Cava Filters: These are not indicated for patients treated with anticoagulation but may be used in patients with contraindications to anticoagulation or those who have failed anticoagulant therapy 6.

Special Considerations

• Duration of Anticoagulation: Current guidelines recommend anticoagulation for a minimum of three months, with the decision to extend anticoagulation based on a risk/benefit analysis 3.
• Pregnancy and Active Cancer: These conditions require special consideration, with long-term use of low-molecular-weight or unfractionated heparin often recommended 3.