One of the strongest memories I have from my teen years is when a good friend of mine was injured in a motorcycle accident. His injuries were relatively minor, but I remember that for years afterward, he was in and out of the hospital periodically because of a dangerous blood clot that had developed from the trauma of the wreck. It seemed so unlikely to me that an otherwise healthy young person could be handicapped by such a hidden foe. Looking back, I now realize that my friend was probably suffering from Thrombophlebitis.
What is Thrombophlebitis?
Thrombophlebitis is the inflammation of a vein in combination with a blood clot in the vein. “Thrombo” means “clot,” and “phlebitis” means “inflammation of a vein.” Thrombophlebitis is also known as phlebitis, phlebothrombosis, and venous thrombosis. Most thrombophlebitis occurs in the arms and legs, with the vast majority being in the legs. However, thrombophlebitis can rarely appear in a vein anywhere in the body. It affects both men and women, and does not usually appear in people under the age of 40.
There are two main types of thrombophlebitis: superficial thrombophlebitis, which affects veins near the surface of the body, and deep vein thrombosis (DVT), which is found in larger veins deep within a muscle. Thrombophlebitis, especially DVT, is a very serious medical condition. Over 600,000 people are hospitalized annually in the United States for DVT, and the prognosis is not very encouraging. Pulmonary embolism, the most common complication of DVT, is the leading cause of preventable in-hospital deaths in America. It takes the lives of over 200,000 patients every year.
What Are the Risk Factors for Thrombophlebitis?
Thrombophlebitis is the result of a blood clot. Blood clots (emboli) can form any time that your circulation is poor. Certain factors that increase your risk include:
- Any period of prolonged inactivity, such as an extended car ride or a long plane trip.
- Extended periods of bed rest, such as when recovering from a heart attack or major surgery.
- A stroke that has caused paralysis in your arms or legs.
- Use of IV (intravenous) needles, a venous catheter, or having a pacemaker. All of these may irritate the blood vessel walls and decrease blood flow, thus increasing the risk of an embolus (clot) forming.
- Having a family history of relatives with a tendency toward blood clot formation.
- Having certain conditions that encourage easy formation of emboli. One example is pancreatic cancer, which may cause elevated blood levels of substances called procoagulants that are vital for healthy coagulation (blood clotting).
- Pregnancy or post partum status: This can increase the pressure in the veins of your legs and pelvis, thus leading to greater risk of emboli forming.
- Usage of oral contraceptives and/or hormone replacement therapy. These medications greatly increase the risk of thrombophlebitis.
- Varicose veins may increase the risk of emboli, leading to superficial thrombophlebitis.
- Any injury or trauma to a vein.
- Infections in a vein.
- Buerger’s disease: A rare condition caused by tobacco use (smoking or smokeless) that is characterized by thrombosis in the hands and feet.
What Are the Symptoms of Thrombophlebitis?
The most common symptoms of thrombophlebitis are:
- Tenderness and pain in the affected area
- The area will be warm to the touch
- Redness and swelling
- With superficial thrombophlebitis, a hard red chord may be visible just under the skin. It can also be tender and painful.
- With DVT, the majority of affected veins are in the leg. The leg may be swollen, tender, and painful, especially when standing or walking. Some patients also exhibit a fever. However, many folks with DVT may have no symptoms, and this can be very dangerous, as they are not motivated to seek help. DVT can lead to a pulmonary embolism, which is when a clot breaks off and lodges in the lungs. This is a potentially fatal condition.
What Complications can Occur from Thrombophlebitis?
The most dangerous complication from thrombophlebitis is a pulmonary embolism, as mentioned above. There are other significant ones to consider as well. They include:
- Heart attack or stroke: Patients with certain congenital defects in the structure of the heart are most susceptible to these complications. A ventrical septal defect or an atrial septal defect (conditions which cause a “hole” to form in the heart) can allow a traveling emboli to enter the arteries of the heart or brain and result in a heart attack or stroke, respectively. While potentially fatal, this is much less common than a pulmonary embolism.
- DVT may also damage special valves in the veins of the legs. These valves keep blood from flowing backward (away from the heart) as it makes its way up the legs and toward the heart. Damage to these valves can allow blood to pool in your legs and cause several complications:
- Swelling: This can become quite serious in some patients. This swelling is referred to as edema.
- Stasis pigmentation: As the result of ongoing edema, the increased pressure on your skin can lead to discoloration. Ulcers of the skin in the affected areas can also become a problem.
- Varicose veins: This is actually the “ballooning” of the veins as a result of blood pooling. They become enlarged and often visible through the skin.
- Vein obstruction: Repeated episodes of DVT can eventually cause a permanent obstruction of the vein. This can be a relatively minor problem or a major health issue, depending on the location of the affected vein.
How is Thrombophlebitis diagnosed?
Superficial thrombophlebitis can usually be detected during a physical exam. Most clots are hard, and can be felt while your health care provider performs palpation (massage) on suspected areas. Superficial thrombophlebitis is often visible as well, with the affected vein appearing as a hard chord.
DVT is a bit harder to determine. Sometimes the symptoms can be severe, such as swelling, pain, or a high fever. But some patients may have no symptoms. If DVT is suspected, there are several diagnostic tests that can be run:
- Ultrasound: Sound waves are used to get an image of what is going on inside your leg tissues. The picture is put onto a video monitor, and if there are any clots, they may be visible. This is not a foolproof test. Not all clots will necessarily show up, but it gives a good overview of any potential problem areas in your veins.
- Venography: This involves taking an x-ray of your legs and feet after a dye has been injected that makes it easier to see any clots.
- There is a blood test that measures the amount of a clot-dissolving substance called D dimer. Most people with DVT have elevated levels of D dimer in their blood. However, the presence of excessive D dimer does not nail down a positive diagnosis of DVT. This substance can be elevated due to other conditions as well.
What Treatments Are Available for Thrombophlebitis?
Superficial thrombophlebitis is often a condition that can be treated mostly through self-care and prevention. In fact, in minor cases that do not give you any pain or discomfort, they usually will clear up on their own with no intervention at all. Often the most effective course of action with superficial thrombophlebitis is to apply moist heat to the area for fifteen to thirty minutes, two or three times per day. It is a good idea to elevate the leg several times a day as well. Other common sense, practical tips include:
- Avoid tight fitting clothing, especially around the waist.
- Make sure you stay well hydrated by drinking plenty of fluids (water is best) throughout the day. It is a good idea to drink a glass of water before bed, and first thing in the morning.
- Get in the habit of walking. Try to get up and move around at least once every hour. Stretching is a good habit as well. Stretching the calves at least once an hour is especially helpful for thrombophlebitis patients.
- Compression hose or support stockings may be advisable as well to provide extra support for your legs.
- Traveling can be especially troublesome for thrombophlebitis sufferers. Here are a few tips to avoid trouble:
- If you must stay seated for long periods of time, move your legs and feet around periodically. Flex your ankles or push down with your feet on the floor or the seat in front of you.
- If you are driving, stop every hour or so and take a short walk. Remember Chinese Firedrills when you were a kid? If you don’t know what they are, then you lived an impoverished childhood. But, just make sure you get ample chances to stretch and walk. It will help you to stay more alert too, if you are the driver.
- On an airplane, especially an extended trip of more than several hours, get up and walk around the cabin every hour or so.
Deep vein thrombosis (DVT) is a much more serious condition, and much more difficult to treat as well. Given the gravity of DVT and its potentially fatal complications, medication is often a necessary course to take. Like any other drug, there are potential side effects that should be considered. But sometimes, as in the case of DVT, the benefits outweigh the risks. Each one of us is responsible for making the best decisions possible when it comes to our health care. There are several common drugs that are often prescribed:
- The first step is usually the administration of a blood thinning (anticoagulant) medication to prevent clots if they have not yet appeared. Heparin is one of the most common.
- The second step, after the heparin, is usually several months of another anticoagulant drug called warfarin (Coumadin). This also prevents clots from growing.
- If these two are not successful, there are drugs available that will dissolve existing clots. You have to be particularly careful with these drugs. You don’t want the clot to dissolve too quickly and break off and end up in your bloodstream or lungs.
- The last resort is surgery. Clots can be removed surgically, and a filter can even be put into the major vein of your abdomen (the vena cava) to keep traveling clots from lodging in your lungs. This type of surgery is very rarely used.