Thrombophlebitis: Deep Vein Thrombosis

The term thrombophlebitis means inflammation of the veins due to blood clots. Thrombophlebitis is generally found in the legs, but can occur in the hands or arms due to IV insertion. Thrombophlebitis can be of two types; superficial thrombophlebitis and deep vein thrombosis.

When the clot forms in the veins, which are near the surface of the skin, it is known as superficial thrombophlebitis. If the clots are formed anywhere deep inside a muscle, it’s called deep vein thrombosis. Superficial thrombophlebitis usually does not cause significant complications, but a deep vein thrombosis can cause serious complications if the clots travel to the lungs and block the pulmonary artery, which carries deoxygenated blood to the heart to be purified. This condition is known as pulmonary embolism.

Symptoms of Thrombophlebitis

In most cases of deep vein thrombosis, there are no related symptoms at all. Patients usually see a physician with symptoms of chest pain or shortness of breath caused by pulmonary embolism resulting from thrombophlebitis. In other cases, the symptoms include pain, warmth, tenderness, swelling, and redness just as in superficial thrombophlebitis.

Causes of Thrombophlebitis

Thrombophlebitis is caused due to blood clots. Blood clots form when the blood is not able to circulate as it should. It could be due to an external cause like injury or due to some hereditary blood clotting disorder like factor V Leiden.

Risk Factors for Thrombophlebitis

There are risk factors that increase the possibility of acquiring thrombophlebitis. Some of them are listed below. The more risk factors you have, the more likely you will have thrombophlebitis.
• Having a tendency of clot formation or any family history of blood clotting disorder.
• Having cancers like pancreatic cancer, which increases the procoagulants that aid in clotting blood.
• Having a pacemaker or catheter; this may affect the wall of the blood vessel and decrease blood flow.
• Being paralyzed due to stroke.
• Being confined to the bed for a long period, either after surgery or after an injury like fracture of the leg or ankle.
• Having varicose veins.
• Being pregnant or having given birth recently, which increases pressure on the leg veins.
• Using contraceptive pills or hormone replacement, which causes blood clots.
• Being inactive for a prolonged period, such as, while travelling in a car or airplane.
• Being obese or overweight.
• Being a smoker.

Prevention of Thrombophlebitis

Some cases of thrombophlebitis can be prevented by simply eliminating as much of the risk factors as possible. For example, if you quit smoking, it reduces your risk of thrombophlebitis.

Similarly, when sitting on a long flight, take hourly walks in the isle, drink plenty of fluids to avoid dehydration, and wear lose clothing especially around the waist. This helps prevent swelling of ankles and calves and reduces the risk of clot formation.

A long car ride can also be a risk factor. Stop the car every hour to get out and take a walk around. If that’s not possible, your feet and ankles, point your toes, or press your feet on the floor of the car and move your legs at regular intervals—say every 20 minutes.

Those with increased risk of deep vein thrombosis should consult their physicians before going for long flights or long drives. The doctor may suggest wearing compression stockings or prescribe blood thinning medication like aspirin to take right before leaving on your trip.

Diagnosis of Thrombophlebitis

The primary checkup done by the physician to diagnose thrombophlebitis includes checking of blood pressure, temperature, pulse, and skin condition. Depending on the initial checkup, the doctor may order tests to confirm thrombophlebitis and/or to determine the type of thrombophlebitis—superficial or deep vein thrombosis. These tests include Doppler ultrasound, MRI (magnetic resonance imaging), CT (computerized tomography) scan, venography, extremity arteriography, or blood coagulation studies.

Complications of Thrombophlebitis

Complications from superficial thrombophlebitis are rare while complications from deep vein thrombosis can range from mild to severe. The possible complications are:
• Severe pain, swelling, and discoloration of the skin of the leg.
• Blocked leg vein or varicose vein, that is, swollen, twisted, painful leg veins.
• Heart attack or stroke. This complication arises in patients with congenital heart diseases like patent foramen ovale, atrial septal defect, or ventricular septal defect.
• Pulmonary embolism – a life-threatening condition caused when a blood clot travels to the lungs and blocks one of the arteries.

When to Seek Medical Care

You should seek medical care when:
• You see symptoms of thrombophlebitis (as described above).
• Symptoms do not improve with treatment.
• Symptoms get worse.
• New symptoms arise.

Treatment of Thrombophlebitis

Self-care and home remedies

Some self-care practices along with medical treatment can improve some of the symptoms and speed up the healing process. Depending on the severity, self-care measures include:

For superficial thrombophlebitis, elevating the affected leg and applying heat with a warm washcloth can bring considerable relief.

For deep vein thrombosis, wearing support stockings and elevating the affected leg, if swollen, can help.

Medications

Over-the-counter NSAIDs are usually helpful in case of superficial thrombophlebitis, but for deep vein thrombosis, the patient may need an injection of an anticoagulant like heparin to thin the blood. This should be followed by taking warfarin for several months to keep the clot from getting bigger. These medications should be taken under the guidance of a doctor, since warfarin has many side effects and can be dangerous if not taken as prescribed.

Support stockings

Supports stockings or strength support hose are often prescribed to prevent swelling and reduce the complications of deep vein thrombosis.

Filter

The blood clots formed in thrombophlebitis may move to the lungs and get lodged, which can be fatal. To prevent this, a permanent filter can be placed in the vena cava, the main vein of the abdomen. This is done for people who cannot take blood thinners.

Varicose vein stripping

One of the complications from thrombophlebitis is varicose veins. Varicose vein stripping is a procedure to remove the problematic vein through a small incision in the skin. This is usually done for the superficial veins and doesn’t cause problem with the blood circulation in the leg. This is mainly done for cosmetic reasons.

Clot removal, bypass

Surgery is done to remove blood clots from the veins either in the abdomen or pelvis. A bypass can be done in cases of persistent clots.

Angioplasty

A nonsurgical procedure, called angioplasty, may be an alternative to bypass. In this procedure, the vein is opened and a small stent is placed in to keep the vein open.

Diet if You Have Thrombophlebitis

The following diet changes can help prevent or reduce the intensity of thrombophlebitis.
• Restricting fat intake as fat causes poor blood circulation and increases the risk of clot formation.
• Eating a high-fiber diet; like vegetables, fruits, grains, nuts, and fish; that are good for the heart.
• Increasing intake of berries, like blackberry, cherry, blueberry, which contain chemicals – proanthocyanidins and anthocyanidins – that improve vein function.
• Increasing intake of ginger, garlic, onion and hot pepper that prevents clot formation due to their blood-thinning properties.
• Taking nutritional supplements like folic acid and vitamins B6, B12, C, E, and B-complex help to improve vein function.

Comments

  1. S. Arrington says:

    Very informative and useful article. I wear compression stockings, which while wearing make your legs feel as if you are having a massage. They are great for reducing swelling and pain and alleviate that “heavy” feeling that occurs with varicose veins.

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