Thrombophlebitis

Thrombophlebitis
Ultrasonographic image showing thrombosis of the great saphenous vein.
Pronunciation
  • throm-boe-fluh-BY-tis[1]
SpecialtyEmergency medicine
SymptomsPain, swelling, redness, warmth, hardening of the vein[2][1]
TypesSuperficial thrombophlebitis, deep vein thrombosis, migratory thrombophlebitis, septic thrombophlebitis[1][3][4]
Risk factorsDeceased mobility, recent surgery, pregnancy, birth control pills, cancer, obesity and at site of an intravenous insertion.[2][1]
Diagnostic methodUltrasound[2]
TreatmentBlood thinners, pain medication[5]

Thrombophlebitis is a inflammation of a vein due to a blood clot.[2] Most commonly the leg is effected.[2] Symptoms may include pain, swelling, redness, warmth, and hardening of the vein.[2][6] In infected fever and low blood pressure may also occur.[4] Complications may include pulmonary embolism and post-thrombotic syndrome.[1]

The most common types are superficial thrombophlebitis and deep vein thrombosis.[1] When it occurs repeatedly in different locations, it is known as migratory thrombophlebitis, and is associated with cancer.[3] When it affects the breasts it is known as Mondor disease.[7] When it is infected it is known as septic thrombophlebitis.[4]

Risk factors include deceased mobility, recent surgery, pregnancy, birth control pills, cancer, obesity, varicose veins, family history, and at site of an intravenous insertion.[2][1] The underlying mechanism may involve poor blood flow, increased blood clotting, and damage to a vein.[1] Diagnosis is generally by ultrasound.[2]

Small clots in superficial vein may resolve on their own.[2] Measures for discomfort, such as NSAIDs and keeping the leg raised, may help.[5] Blood thinners, such as heparin, warfarin, or apixaban, are also frequently used.[5] Occasionally a vena cava filter or alteplase may be used.[5] Those over the age of 60 are more commonly affected.[1]

Signs and symptoms

Deep vein thrombosis of the right leg

The following symptoms or signs are often associated with thrombophlebitis, although thrombophlebitis is not restricted to the veins of the legs.[8][9]

Complications

In terms of complications, one of the most serious occurs when the superficial blood clot is associated with a deep vein thrombosis; this can then dislodge, traveling through the heart and occluding the dense capillary network of the lungs This is a pulmonary embolism which can be life-threatening.[10]

Causes

Thrombophlebitis causes include disorders related to increased tendency for blood clotting and reduced speed of blood in the veins such as prolonged immobility; prolonged traveling (sitting) may promote a blood clot leading to thrombophlebitis but this occurs relatively less. High estrogen states such as pregnancy, estrogen replacement therapy, or oral contraceptives are associated with an increased risk of thrombophlebitis.[8][9][11]

Specific disorders associated with thrombophlebitis include superficial thrombophlebitis which affects veins near the skin surface, deep vein thrombosis which affects deeper veins, and pulmonary embolism.[12]

Those with familial clotting disorders such as protein S deficiency, protein C deficiency, or factor V Leiden are also at increased risk of thrombophlebitis. Thrombophlebitis can be found in people with vasculitis including Behçet's disease. Thrombophlebitis migrans can be a sign of malignancy – Trousseau sign of malignancy.[13]

Diagnosis

The diagnosis for thrombophlebitis is primarily based on the appearance of the affected area. Frequent checks of the pulse, blood pressure, and temperature may be required. If the cause is not readily identifiable, tests may be performed to determine the cause, including the following:[8][9]

Prevention

Prevention consists of walking, drinking fluids and if currently hospitalized, changing of IV lines.[8] Walking is especially suggested after a long period seated, particularly when one travels.[14]

Treatment

Ibuprofen

In terms of treatment for this condition the individual may be advised to do the following: raise the affected area to decrease swelling, and relieve pressure off of the affected area so it will encounter less pain. In certain circumstances drainage of the clot might be an option. In general, treatment may include the following:[8][9][10]

Epidemiology

Thrombophlebitis occurs almost equally between women and men, though males do have a slightly higher possibility. The average age of developing thrombophlebitis, based on analyzed incidents, is 54 for men and 58 for women.[10]

References

  1. 1 2 3 4 5 6 7 8 9 "Thrombophlebitis - Symptoms and causes". Mayo Clinic. Archived from the original on 26 February 2021. Retrieved 28 February 2021.
  2. 1 2 3 4 5 6 7 8 9 Torpy JM, Burke AE, Glass RM (July 2006). "JAMA patient page. Thrombophlebitis". JAMA. 296 (4): 468. doi:10.1001/jama.296.4.468. PMID 16868304.
  3. 1 2 Jinna, Sruthi; Khoury, John (2020). "Migratory Thrombophlebitis". StatPearls. StatPearls Publishing. Archived from the original on 2021-08-29. Retrieved 2020-02-29.
  4. 1 2 3 Lipe, DN; Foris, LA; King, KC (January 2021). "Septic Thrombophlebitis". PMID 28613482. {{cite journal}}: Cite journal requires |journal= (help)
  5. 1 2 3 4 "Thrombophlebitis - Diagnosis and treatment - Mayo Clinic". www.mayoclinic.org. Archived from the original on 19 January 2021. Retrieved 28 February 2021.
  6. ↑ "Thrombophlebitis - Symptoms and causes". Mayo Clinic. Archived from the original on 26 February 2021. Retrieved 28 February 2021.
  7. ↑ Czysz, A; Higbee, SL (January 2021). "Superficial Thrombophlebitis". PMID 32310477. {{cite journal}}: Cite journal requires |journal= (help)
  8. 1 2 3 4 5 "Thrombophlebitis: MedlinePlus Medical Encyclopedia". medlineplus.gov. Archived from the original on 8 September 2018. Retrieved 23 September 2016.
  9. 1 2 3 4 "Thrombophlebitis Clinical Presentation: History, Physical Examination, Causes". emedicine.medscape.com. Archived from the original on 2 October 2018. Retrieved 23 October 2016.
  10. 1 2 3 Raval, P. (1 January 2014). Thrombophlebitis☆. Reference Module in Biomedical Sciences. doi:10.1016/B978-0-12-801238-3.05368-X. ISBN 9780128012383.
  11. ↑ Philbrick, John T.; Shumate, Rebecca; Siadaty, Mir S.; Becker, Daniel M. (23 October 2016). "Air Travel and Venous Thromboembolism: A Systematic Review". Journal of General Internal Medicine. 22 (1): 107–114. doi:10.1007/s11606-006-0016-0. ISSN 0884-8734. PMC 1824715. PMID 17351849.
  12. ↑ "Superficial Thrombophlebitis: Background, Pathophysiology, Etiology". eMedicine. Medscape. 12 July 2016. Archived from the original on 24 October 2016. Retrieved 23 October 2016.
  13. ↑ Varki, Ajit (15 September 2007). "Trousseau's syndrome: multiple definitions and multiple mechanisms". Blood. 110 (6): 1723–1729. doi:10.1182/blood-2006-10-053736. ISSN 0006-4971. PMC 1976377. PMID 17496204.
  14. ↑ Tamparo, Carol D. (2016). Diseases of the Human Body. F.A. Davis. p. 292. ISBN 9780803657915. Archived from the original on 29 August 2021. Retrieved 23 October 2016.
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