Thrombophlebitis

Thrombophlebitis is when a blood clot forms in one of your veins and slows down the blood flow in the vein. It most often affects your legs, but it can also happen in your arms or other veins in your body. Thrombophlebitis can happen right under the skin or deeper in your leg or arm.

"Thrombo" means clot, and "phlebitis” means inflammation in a vein. That’s the swelling and irritation that result after an injury.

What Are the Types of Thrombophlebitis?

Phlebitis and thrombosis of the lower extremity superficial veins . You might also hear this called superficial phlebitis or superficial thrombophlebitis. It’s a blood clot in the vein just below surface of your skin. It doesn’t usually get to your lungs, but superficial thrombophlebitis can be painful, and you may need treatment.

Deep vein thrombosis  (DVT). It's a blood clot in a vein deep in your body. Most happen in your lower leg or thigh, but they may happen in other parts of your body. A clot like this can get loose and travel through your bloodstream. If it gets to an artery in your lungs and blocks blood flow, it’s called a pulmonary embolism, which can damage your lungs and cause death.

Migratory thrombophlebitis. Also called Trousseau's syndrome or thrombophlebitis migrans, it's when the clot comes back in a different part of your body. If often goes from one leg to the other. It’s often linked to cancer, especially of the pancreas or lung.

What Are the Symptoms of Thrombophlebitis?

If the blood flow to one of your veins is slowed because of a clot, you might have:

  • Red, swollen, and irritated skin around the affected area
  • Pain or tenderness that gets worse when you put pressure on the affected area
  • A swollen vein that feels like a tough "cord" under your skin
  • Pain when flexing your ankle (keep in mind that thrombophlebitis can happen in other parts of the body, but it usually happens in the legs)
  • A swollen foot or ankle

If you have any of these symptoms, see your doctor right away. She’ll do a physical exam. She may also do blood and circulation tests or imaging exams like a CT scan or MRI.

Call 911 if you have leg pain or swelling or any of the following symptoms:

  • One leg seems warmer than the other or is swollen, red, painful, or irritated
  • The affected limb becomes pale or cold, or you start feeling chills and fever
  • Sudden coughing, which may bring up blood
  • Sharp chest pain or chest tightness
  • Pain in your shoulder, arm, back, or jaw
  • Rapid breathing or shortness of breath
  • Pain when you breathe
  • Severe lightheadedness
  • Fast heartbeat

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What Causes It?

First, a blood clot forms. This can be due to several things. Most often, it’s caused by blood not moving the way it should through the leg veins. This can result from:

Long-term bed rest, such as after a major illness or surgery.

Sitting for a long time, like in a car or on a plane or some other place where you can’t stretch your legs.

Varicose veins  can lead to thrombophlebitis, too. They cause your blood vessels to stretch too much. This allows blood to pool in the vessel instead of flowing straight through in one direction. This can lead to blood clots.

Who’s at Risk?

Anyone who has poor circulation in their legs may be more likely to have this condition. This could include pregnant women, who may develop thrombophlebitis during or after pregnancy. People who’ve been kept in the hospital on an IV are at risk, too. And while hospital staffers try to lower this risk by changing the spots where IV lines are placed in the body, thrombophlebitis is still possible.

Other things that raise your chances of having this condition include:

How Is It Diagnosed?

The doctor will start by asking about your symptoms and taking a look at veins near the surface of your skin. He might also do tests like:

Duplex ultrasound. This painless imaging test doesn’t have radiation like an X-ray does. It uses sound waves to create a picture of your legs. The doctor spreads warm gel on your skin, then rubs a wand over the area where she thinks the clot is. The wand sends sound waves into your body. The echoes go to a computer, which makes pictures of your blood vessels and sometimes the blood clots. A radiologist or someone who’s specially trained has to look at the images to explain what's going on.

Blood tests. If the doctor thinks you’re at low risk for a clot, she’ll check your levels of D-dimer, a substance that shows up in your blood when you have a clot. If the test is normal, you might not need more tests.

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How Is Thrombophlebitis Treated?

Most cases of thrombophlebitis that happen in the shallow veins begin to go away by themselves in a week or two. But on rare occasions, these blocked veins can lead to infection. They can even cause tissue damage from the loss of healthy circulation.

But if you do need treatment, your doctor will probably give you something to relieve swelling and pain. He may recommend you elevate your leg or take over-the-counter aspirin or ibuprofen. He might also suggest you apply heat to the affected leg for 15 to 30 minutes two to three times daily.

Antibiotics . You might get them if poor circulation leads to an infection.

Blood thinner s . These medications are usually reserved for more severe cases. You can give yourself heparin (Porcine) and enoxaparin (Lovenox)  to yourself at home through shots under your skin. They help keep the clot from getting bigger. You may also have to take an oral drug like warfarin (Coumadin) for several months or longer to keep clots from coming back. Your doctor will give you regular blood tests to make sure the meds are working.

Newer blood thinners, like direct thrombin inhibitors and factor Xa inhibitors, are also available. But doctors don’t normally recommend them as the main treatment for thrombophlebitis. That’s because they cost more and may cause uncontrollable bleeding. They include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).

Compression stockings . The doctor may tell you that you need to wear these thick stockings that go from toes to knee. They improve blood flow to your legs and ease swelling. You might hear them called support hose.

Filter. You might need it if there’s a high risk of tissue damage or if your clot comes back. If you have a clot in a deep vein in your leg and cannot tolerate blood thinners, your doctor might recommend an inferior vena cava (IVC) filter. The vena cava is the main vein in your abdomen. The IVC filter prevents clots in your legs from breaking loose and traveling to your lungs. You’ll need surgery for this treatment.

Varicose vein stripping. This can help with veins that cause pain or recurring thrombophlebitis. The doctor makes small cuts to remove a long vein. It doesn’t affect circulation -- veins deeper down can handle more blood.

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Complications

They’re rare, but you could have:

Pulmonary embolism. If the clot breaks loose, it could move to your lungs and block an artery. This condition can be life-threatening.

Postphlebotic syndrome. It can show up months or years after DVT. It often causes pain, swelling, and a feeling of heaviness in the affected leg or arm. You might hear it called post-thrombotic syndrome, venous stasis syndrome, or chronic venous insufficiency.

Can It Be Prevented?

Sitting on long drives or flights is a major cause of blood clots. To prevent them, you can:

  • Walk around. Get up for a stroll every hour.
  • Keep moving. Don’t just sit there. Flex your ankles. Or press your feet against the floor or footrest about 10 times an hour.
  • Keep it loose. Don’t wear tight clothing.
  • Stay hydrated. Drink plenty of fluids, but avoid alcohol.
WebMD Medical Reference Reviewed by Sabrina Felson, MD on November 04, 2019

Sources

SOURCES: 

Mayo Clinic: “Thrombophlebitis.” 

Merck Manuals: “Superficial Venous Thrombosis: Heart and Blood Vessel Disorders.”

Medline Plus: "Deep venous thrombosis."

University of Michigan Health System: “Vascular Surgery.”

Medscape: “Superficial Thrombophlebitis Clinical Presentation.”

Cleveland Clinic: “Superficial Thrombophlebitis.”

NIH National Heart, Lung, and Blood Institute: “What Is Deep Vein Thrombosis?”

UpToDate: ‘Phlebitis and thrombosis of the superficial lower extremity veins.”

National Blood Clot Alliance: “Post-Thrombotic Syndrome.”

University of Rochester: “D-Dimer.”

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