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Superficial Thrombosis and thrombophlebitis

Introduction

Superficial thrombophlebitis is a common inflammatory thrombotic disorder in which a blood clot or thrombus develops in a vein located near the surface of the skin and results in secondary inflammation. Most superficial veins that develop thrombosis also develop phlebitis, an inflammatory process in the vein.

Superficial thrombophlebitis is usually a benign, self-limiting disease, however it can be recurrent, persistent, and at times cause significant incapacitation. It can also indicate the presence of venous insufficiency (varicose veins) or cancer if in a non-varicosed vein.

The superficial veins connect to deep veins. Blood clots in the superficial veins can, therefore, travel into the deep system. This can be life threatening if the clot then breaks off. It can also lead to extensive deep venous thrombosis and secondary post thrombotic syndrome. For these reasons it is very important a venous ultrasound is performed to define the extent of the clot and to exclude a clot in the contra-lateral leg.

Causes

There are three factors leading to thrombosis. Generally, the formation of thrombus requires two of the three factors. These are blood stasis, alteration to the vein wall and hypercoagulability (sticky blood).

You are at more risk of developing a Superficial Thrombophlebitis if you have the following:

  • Metabolic syndrome.
  • Previous history of blood clots.
  • Personal or family history of a clotting disorder.
  • Recent major surgery or injury.
  • Hospitalisation.
  • History of active cancer and concurrent cancer therapy.
  • Smoking.
  • Obesity or being overweight.
  • Hormone replacement therapy or high dose combined oral contraceptive pill.
  • Pregnancy and first six weeks after delivery.
  • Prolonged sitting, that is greater than 6-8 hours.

Symptoms

Tenderness associated with redness along the course of the vein, local swelling and warmth. Often these signs and symptoms are mistaken for infection. Infection, however, would generally be accompanied by systemic symptoms such as fever, loss of appetite and malaise.

Diagnosis

  • Physical examination.
  • Ultrasound.

Treatment

Superficial Thrombophlebitis is best treated with:

  • Properly fitted compression.
  • Hirudoid cream – massage into the affected area morning and night.
  • Walking (half an hour each day).
  • Anti-inflammatory medication such as Nurofen – for 48 hours.

In some instances, your doctor will recommend a blood thinning medication.