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Understanding Thrombophlebitis -- Diagnosis and Treatment

How Do I Know If I Have Thrombophlebitis?

The discomfort and appearance of a leg affected with thrombophlebitis is usually enough for a doctor to diagnose this condition. Taking your pulse and blood pressure also can help. But depending on the blood vessel involved, symptoms may or may not be obvious, and your doctor may have to order tests to determine whether this condition is causing problems.

Ultrasound uses sound waves and a computer to create images of the affected area to help your doctor determine if a clot is present and blocking the blood flow. Veins with a healthy circulation look different than a vessel with thrombophlebitis.

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But there are some veins in the leg that don't show up well on ultrasound, especially the deep veins close to the knee. It can be difficult or impossible to tell if you have circulation problems present in these "blind spots." Your doctor may perform an older test called a venogram, where dye is injected into the foot and is directed into the affected vessel as the blood makes its way back to the heart. The dye will show up on X-ray, giving a picture of the inside of the vein. The clots themselves don't show up, but your doctor can tell how much dye is traveling through the leg and note where blood flow stops due to the clot.

A blood test can also be done to check for a substance called D-dimer. D-dimer is formed when blood clots are broken down. A negative test significantly lowers the likelihood of a clot. A positive test may indicate a clot, but it also can indicate other causes.

What Is the Treatment for Thrombophlebitis?

Treatment for thrombophlebitis varies according to severity. When a superficial blood vessel is involved, the condition may begin to get better in a week or two. Treatment focuses on reducing swelling and pain. All you may need is to take aspirin or ibuprofen (like Motrin or Advil) and apply heat to the leg for 15 to 30 minutes two to three times daily.

Some people may need to wear support hose or stockings or have their leg wrapped to apply pressure to the leg and reduce swelling. Elevating the leg can also prevent excess fluid from pooling in the affected area.

More severe cases may require a trip to the hospital to receive IV drugs like heparin or injections such as low-molecular weight heparin or fondaparinux (Arixtra) to help keep the clot from getting larger. This will usually be followed by treatment with an oral drug like warfarin (Coumadin) for several months or longer to prevent clots from returning. This will require frequent blood tests to monitor the effectiveness of the medication. 

Newer blood thinners are available that do not need such frequent monitoring, but these are not usually recommended as the first-line treatment for thrombophlebitis. These newer medicines have a higher cost and they may cause irreversible bleeding. They include: rivaroxaban (Xarelto), apixaban (Eliquis), edoxaban, and dabigatran (Pradaxa) Of these, only rivaroxaban (Xarelto) is approved in the United States to treat deep vein thrombosis.

Serious thrombophlebitis may also need treatment with antibiotics to kill infections that could develop from the circulation problem. If there is a high risk of tissue damage, surgery may be needed to strip out the vein or bypass the clot with a transplanted vessel. An alternative to surgery or medicine is placing a filter in the main vein in the abdomen, called the vena cava, to prevent clots in the legs from dislodging and traveling to the lungs.

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