Treatment of Thrombophlebitis
For superficial thrombophlebitis (SVT) of the lower limb at increased risk of progression (≥5 cm in length in the greater saphenous vein), anticoagulation for 45 days is recommended over no anticoagulation. 1
Anticoagulation Therapy
First-Line Treatment
- Fondaparinux 2.5 mg daily for 45 days is the preferred anticoagulation regimen for superficial thrombophlebitis at risk of progression 2
- Low molecular weight heparin (LMWH) for 4 weeks is an alternative option for patients with thrombosis length exceeding 5 cm 2
- Dalteparin has demonstrated superiority over NSAIDs in preventing thrombus extension during the treatment period 3
High-Risk Features Requiring Anticoagulation
- SVT within approximately 3 cm of the saphenofemoral junction should be treated with the same approach as proximal DVT (minimum 3 months of anticoagulation) 1
- Treatment trials specifically enrolled patients with SVT in the greater saphenous vein of at least 5 cm in length 1
Supportive Measures
Mobility and Compression
- Early ambulation is recommended over bed rest in patients with thrombophlebitis 1
- Bed rest should be avoided as immobilization does not prevent complications and may worsen outcomes 4
- Compression therapy should be used, though ambulation may need to be deferred if edema and pain are severe 1
Symptomatic Treatment
- Topical NSAIDs applied locally to the affected area control symptoms effectively 5
- Hirudoid cream (heparinoid) shortens the duration of signs and symptoms 5
- Locally acting anticoagulants/antithrombotics have positive effects on pain and reduction in thrombus size 5
- Oral NSAIDs (such as ibuprofen) provide pain relief but are inferior to anticoagulation for preventing thrombus extension 3
Critical Caveats
When to Avoid Anticoagulation
- Do not anticoagulate gastrocnemius hematomas (tennis leg syndrome) unless concurrent DVT is confirmed, as heparinization can lead to compartment syndrome requiring aspiration and prolonged recovery 4
- Antibiotics are not indicated unless documented infection is present 5
Catheter-Related Thrombophlebitis
- Intravenous catheters should be changed every 24-48 hours to prevent thrombophlebitis 5
- Remove vein lines immediately if thrombophlebitis develops 5
- LMWH prophylaxis and nitroglycerin patches distal to peripheral lines may reduce incidence in patients with vein catheters 5
Monitoring and Follow-Up
- Daily ultrasound assessment should be performed in acute thrombophlebitis, even during anticoagulation therapy, as thrombus progression from the thigh to the saphenofemoral junction can occur within hours 2
- Assess for concurrent deep vein thrombosis bilaterally, not only in the affected limb 2
Surgical Intervention
- Emergency crossectomy and phlebectomy may be considered for acute ascending thrombophlebitis near the saphenofemoral/saphenopopliteal junction, though this is not the first-line recommendation per current guidelines 2
- Surgical treatment is particularly relevant in pregnant women with thrombophlebitis in later phases of pregnancy 2