From the Guidelines
Superficial thrombophlebitis should be treated with anticoagulation, specifically fondaparinux 2.5mg subcutaneously once daily for 45 days, in patients at increased risk of clot progression to deep vein thrombosis (DVT) or pulmonary embolism (PE) 1.
Diagnosis and Treatment
Superficial thrombophlebitis is an inflammatory condition of the superficial veins, typically in the legs, characterized by vein inflammation with clot formation. The diagnosis is primarily clinical, based on symptoms such as pain, redness, and swelling in the affected limb.
Conservative Measures
For mild cases, conservative measures include:
- Rest
- Leg elevation
- Warm compresses
- Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen 400-600mg three times daily for 7-10 days to reduce pain and inflammation
- Compression stockings providing 20-30 mmHg pressure should be worn during the day to improve blood flow and reduce swelling
Anticoagulation Therapy
For more severe cases or those involving the great saphenous vein, anticoagulation with fondaparinux 2.5mg subcutaneously once daily for 45 days is recommended to prevent extension into deep veins 1. Alternatively, rivaroxaban 10mg daily can be considered for patients who refuse or are unable to use parenteral anticoagulation 1.
Monitoring and Prevention
Patients should be monitored for progression to deep vein thrombosis, particularly if the thrombophlebitis is near the saphenofemoral junction. Ambulation is encouraged rather than bed rest, as movement helps prevent clot extension. Risk factors include varicose veins, recent surgery, pregnancy, hormone therapy, and prolonged immobility, so addressing these underlying factors is important for prevention of recurrence. If symptoms worsen, especially with increasing pain, redness extending upward, or development of fever, medical attention should be sought promptly.
From the Research
Diagnosis of Superficial Thrombophlebitis
- Superficial thrombophlebitis is characterized by clotting of superficial veins with minimal inflammatory components, or a minimally thrombotic process of superficial veins associated with inflammatory changes and/or infection 2
- Diagnosis can be made using duplex ultrasonography to rule out deep venous thrombosis (DVT) 3
- It is essential to consider underlying diseases such as tumors, infections, or disorders of coagulation 4
Treatment of Superficial Thrombophlebitis
- Treatments generally include analgesics, elastic compression, anti-inflammatory agents, exercise, and ambulation 2
- Topical analgesia with nonsteroidal anti-inflammatory creams or heparinoid creams can control symptoms 2
- Locally acting anticoagulants/antithrombotics can have positive effects on pain and reduction in thrombus size 2
- Low molecular weight heparin (LMWH) can be effective in preventing extension of superficial thrombophlebitis and reducing pain 5, 6
- Anticoagulants may be necessary in cases of neoplastic diseases or hematological disorders 2
- Surgery with high saphenous ligation and/or saphenous vein stripping may be considered in some cases, especially with involvement of deep veins 5
Prevention of Superficial Thrombophlebitis
- Prevention should be considered based on patient's history and clinical evaluation 2
- Low molecular weight heparin prophylaxis and nitroglycerin patches may reduce the incidence of superficial vein thrombosis/superficial thrombophlebitis in patients with vein catheters 2
- Regular changing of intravenous catheters and removal in case of events can help prevent superficial thrombophlebitis 2
- Exercise and ambulation can reduce pain and the possibility of deep vein thrombosis 2