Thrombophlebitis: Symptoms, Causes, Treatment, Cost, and Side Effects

Thrombus is a clot of blood. Phlebitis means inflammation of a vein. When a clot of blood forms and creates a block in the vein, it is termed as thrombophlebitis. The clot generates inflammation in the vein at the location of the clot. Thrombophlebitis is often termed as thrombosis of the vein. It is most prevalent in the legs. On occasions, thrombophlebitis has been known to have occurred in the arms and neck too.

Types of thrombophlebitis are differentiated by the location of their occurrence. Most common locations are veins under the skin which is known as superficial thrombophlebitis. A second type of thrombophlebitis is migratory thrombophlebitis. Also known as thrombophlebitis migrans, this is a condition in which blood clots occur in several veins comprising a group and gradually spread to several groups of veins.

You may also get afflicted with deep vein thrombosis (DVT) or phlebothrombosis whereby blood clots form in the deep veins within the body. DVT does not cause externally visible inflammation of the vein as such. Thus, if we check phlebothrombosis vs thrombophlebitis, the differentiation lies in the presence (thrombophlebitis) or absence (phlebothrombosis) of externally visible inflammation.

Phlebothrombosis runs the risk of the clot travelling through the bloodstream to the lungs. This may stop the flow of blood creating a potentially threatening condition known as pulmonary embolism.

The following are typically the thrombophlebitis symptoms:

• Swelling at the affected location of the vein.
• Redness observed at the location.
• Tenderness felt over the affected vein.
• Pain at the affected location.
• A feeling of warmness at the spot.
• Increasing discomfort as in cases of muscle pain (often mistaken as such).

There are several causes for thrombophlebitis. Chief thrombophlebitis causes are:

• Long periods of inactivity due to being bedridden as happens after a surgery or trauma.
• Sitting for prolonged periods as in flights or drives of long duration.
• An injury or trauma to your arm or leg may induce thrombophlebitis in your vein.
• Although not very common, yet an injury to your blood vessel arising out of an intravenous needle or a catheter, also become reasons for thrombophlebitis.
• Pregnancy, obesity and varicose veins too are reasons for thrombophlebitis.
• Smoking, hormone therapy and birth control pills are known thrombophlebitis causes.
• Being above 60, using a pacemaker, family history or personal incidences of thrombophlebitis have also been identified as thrombophlebitis causes.
• Cancer treatment is known to induce thrombophlebitis.
• Auto-immune diseases are also known to have caused thrombophlebitis.
• Thrombosis patients are susceptible to thrombophlebitis.

Dos

• Make sure to do some stretching and walking if you are on a long flight, long drive or engaged in work that requires you to remain seated for long hours at a time.
• Ensure that your intravenous channel is changed from time to time when hospitalised.
• Ask the nurse or attendant for anticoagulant medication to prevent thrombophlebitis while under hospitalisation.
• Drink fluids in plenty, especially when in long air or car journeys.
• Those at higher risk of thrombophlebitis are often advised to use compress stockings as a preventive measure against thrombophlebitis.

Don'ts

• Do not remain seated for long hours, even during air or car travel over long distances.
• Avoid wearing tight clothing, especially for prolonged periods.
• Insist of some movement or flexing of the ankles, wrists, knees and elbows if it is essential that you are confined to bed for treatment.

Superficial thrombophlebitis is diagnosed by a combination of the symptoms and through physical examination. If the symptoms are not pronounced, some tests may be advised. nIn cases where DVT is suspected, tests need to be adopted for diagnosis.

A vascular ultrasound examination is the most common diagnostic test for thrombophlebitis. A MR angiography (enlarged MRI) or a CT scan too are done at times. A venogram (an x-ray after injection of dye) too may be advised. Blood tests like D-dimer and INR (international rationalised ratio) may be done, but they are more indicative than conclusive as they relate to several other conditions too.

Check if you have developed one or more of the following –

• Pain in the thigh or leg (most commonly affected).
• Such pain is accompanied by swelling at the pain spot.
• You are able to feel a lump or mass just below your skin at and around the pain spot.
• Your skin shows some amount of redness at the location.
• Your skin feels warm and soft at the location at and around it.
• If your checks show positive for one or more of these, you are likely to have developed thrombophlebitis.

Home treatment for thrombophlebitis are:

• Application of warm cloth over the affected area a number of times a day.
• Keep your leg raised i.e. in an elevated position as much as possible.
• Wearing support or compression stockings.
• Consuming non-steroid anti-inflammatory medicine (NSAID) available over the counter (OTT).

Superficial thrombophlebitis will go away on its own more often than not.

Foods that act as blood thinners are good against thrombophlebitis. Such foods include-

• Turmeric.
• Ginger.
• Garlic.
• Cayenne pepper (a red chilly belonging to the capsicum family).
• Foods rich in vitamin E such as almonds, spinach, sunflower oil, peanut butter etc.n
• Cinnamon.
• Grape seed extract.
• Pineapple and pineapple extract.
• Aloe vera juice and extract.
• Plenty of water and other fluids, especially citrus juices without any additives.

Foods that have an adverse impact on your cardiovascular health are usually bad for thrombophlebitis too. These would therefore be –

• Dairy products like butter, ghee, cheese etc. consisting of full fat including full fat milk.
• Fatty meats like ham, pork, beef, mutton etc.
• All forms and types of sugar e.g. cakes, pastries, syrups, canned juices, aerated drinks etc.
• Unhealthy trans-fats as in fast foods, chips, French fries, cookies, fried chicken, nuggets etc.

Superficial thrombophlebitis treatment consists of mostly DIY advice at home like application of warm cloth, wearing compression stockings, keeping the leg in an elevated position and OTT anti-inflammatory medicine without steroids on SOS basis if pain persists. Usually superficial thrombophlebitis will heal by itself in a few days.

Application of gel spray or thrombophlebitis treatment cream for deep penetration into the skin and tackling inflammation and pain helps faster healing.

If the condition does not improve or your doctor suspects heavy clotting, blood thinners and clot dissolving medication may be prescribed. Blood thinning medicine is to be taken under medical advice only. Pristyn Care may be contacted for sound medical guidance if you suspect thrombophlebitis.

For recurring instances of thrombophlebitis, you are best treated by a varicose vein stripping, which is a surgical procedure. There are cases where blood thinners cannot be prescribed. In such instances, another surgical procedure known as vena cava filter may be adopted.

Thrombophlebitis is generally benign and does not call for urgent care. However, there are instances where thrombophlebitis has led to deep vein thrombosis i.e. phlebothrombosis. This condition may lead to complications by developing into pulmonary embolism which is a serious condition. Do go in for urgent care if the following symptoms start to show up in conjunction with leg pain, swelling or redness etc.:

• Difficulty or pain while breathing.
• Increase in heartbeat.
• The affected leg (or arm, as may be) feels cold or becomes pale.
• You feel chilly and get a fever.
• Feel shoulder pain or even pain in your jaw or arm or at the back.
• Your chest feels tight or you get sharp pain in your chest.
• You have a sudden bout of cough, with or without blood emission.
• Your head feels substantially light, your breathing becomes very rapid or you feel short of breath.

In terms of medicine, the following types of medication are effective against thrombophlebitis:

• Medicines that thin out your blood and thus prevents it from forming clots.
• Medicines that help dissolve blood clots.

In the majority of incidences, superficial thrombophlebitis goes away in a few weeks by itself. If pain is quite uncomfortable, a non-steroid anti-inflammatory (NSAID) medicine may be taken, preferably under medical advice. Application of gel sprays or thrombophlebitis ointments help relieve the pain and relax the area. Warm cloth application, keeping the leg or arm, as may be, elevated also helps. Using a compression stocking also helps the clot to dissolve out.

Surgical removal of the varicose vein is the surgical treatment for thrombophlebitis. Pristyn Care has excellent arrangements for providing the latest and dependable surgical treatment of thrombophlebitis.

• The surgery, which is also known as varicose vein stripping as well as phlebectomy, removes the varicose veins that are the source of the recurrent thrombophlebitis and its resultant pain. Several small cuts are made to remove a long vein. With a vein thus cut off, other deep lying veins in the leg take over the burden of maintaining the flow of blood.n
• The procedure is done under general anaesthesia or spinal anaesthesia, numbing the lower part of your body.n
• The surgery is done with 2 to 3 cuts around the top, middle and lower end of the clotted vein, usually between your groin and ankle.n
• A thin wire made of plastic gets inserted into the affected vein from around the groin and passed down to the ankle.n
• The upper end of the wire is tied to the vein.n
• The wire is thereafter pulled out from the lowest cut, and it emerges with the affected vein.n
• In case there are other smaller veins below the skin surface affected with clots, further cuts may be made and the ends of such veins tied off or the vein gets completely removed. This is termed as ambulatory phlebectomy.n
• Stitches will be done to close the cuts made.n
• Your leg will be bandaged and usually wearing compression stockings is prescribed.n
• The procedure consumes about 60 to 90 minutes.

Surgical treatment of thrombophlebitis costs in the range of Rs. 1 lakh to Rs. 2.75 lakhs. The variation is as much due to city location as it is due to the involvement required in the surgical process.

Varicose vein stripping takes between 2 and 4 weeks to heal, depending on the number and location of cuts that were made. You will be prescribed medicines and other instructions to relieve pain and hasten the healing process.

• Surgical treatment of thrombophlebitis is a proven, permanent treatment and prevents recurrence.
• When the surgery is done by skilled and efficient doctors like the ones at Pristyn Care, the results of the surgery will be permanent.

• Wound care: You will be required to take care of your surgical wounds. You will be asked to take care of the bandage and may also be asked to check your wound by removing the bandage and reapplying it.nWearing the compression stocking: Except for bathing and retiring for bed, you will be instructed to wear your stocking through the day for about three weeks.
• Medication: The prescription doses and duration must be strictly adhered to irrespective of the fact that you may be feeling much better.
• Bruise treatment: Apart from the incision sites, there may be bruising in your leg. You will be advised during discharge about taking care of them. The bruises may take some time to heal and are likely to be painful for the first few days.
• Bathing / showering: You will need to avoid soaking your bandage. Do remember to remove your stocking before going for your bath. Pat the affected leg dry without attempting to rub it.
• Becoming mobile: You are likely to be advised for taking walks twice every day for about 20 minutes each, at a comfortable pace. Climbing stairs and walking uphill are out of bounds. Standing is to be avoided, as is driving, swimming or any other form of sport. Make sure to keep your leg elevated while you sit. These restrictions will be gradually removed through reviews during your follow up visits to the doctor.
• Travel: Travel by car or air may only resume after your doctor permits so.

Side effects of thrombophlebitis surgery may be –

• Increasing pain in your wounds.
• Redness that increases gradually.
• Your leg feels hot when touched.
• Any sign of blood or infection at or around incision sites.
• In any of these conditions, contact your doctor on an urgent basis.

Thrombophlebitis is in itself a generally benign condition. The condition usually gets resolved by itself in a matter of 1 to 2 weeks. Recurring thrombophlebitis gets cured through varicose vein stripping. Some research works have however shown a correlation between thrombophlebitis and deep vein thrombosis (DVT). DVT is known to lead to the potentially fatal condition of pulmonary embolism. A Homan’s sign test may be performed to rule out the possibility of DVT in thrombophlebitis patients. nWith safeguard against the possibility for DVT, the prognosis for thrombophlebitis remains good.