What Is Thrombophlebitis?
Thrombophlebitis is when a blood clot forms in one of your veins, causing inflammation. It most often affects your legs but also can affect your arms or other veins in your body. Thrombophlebitis can happen right under the skin or deeper in your leg or arm.
"Thrombo" means clot, and "phlebitis" means inflammation in a vein. That’s the swelling and irritation that happen after an injury.
Thrombophlebitis Types
Superficial thrombophlebitis. This is a blood clot in the vein just below the surface of your skin. It doesn’t usually get to your lungs, but superficial thrombophlebitis can be painful, and you may need treatment.
Deep vein thrombosis (DVT). This is a blood clot in a vein deep in your body that can occur with or without phlebitis. Most happen in your lower leg or thigh, but they may affect other parts of your body. A clot like this can get loose and travel through your bloodstream. If it gets to an artery in your lungs and blocks blood flow, it’s called a pulmonary embolism, which can damage your lungs and cause death. This is what makes DVTs more dangerous than superficial vein thrombosis. DVTs require blood thinners.
Migratory thrombophlebitis. Also called Trousseau's syndrome or thrombophlebitis migrans, this happens when the clot comes back in a different part of your body. It often goes from one leg to the other. It can be linked linked to cancer, especially of the pancreas or lung.
Superficial migratory thrombophlebitis. This is a type of recurring clot that moves around among veins close to the surface of your skin. It usually affects your arms, legs, or trunk.
Suppurative thrombophlebitis. It's also called septic thrombophlebitis. When you have this condition, your clot is caused by an infection or leads to an infection. It can cause serious complications, including:
- Lemierre syndrome, when an upper respiratory infection spreads to your jugular vein
- Pylephlebitis, which involves your portal veins, which carry blood from your gastrointestinal system to your liver
- Septic embolism, when an infected clot breaks free, potentially spreading infection and blocking veins
Thrombophlebitis Symptoms
If blood flow to one of your veins slows because of a clot, you might have:
- Red, swollen, and irritated skin around the affected area
- Pain or tenderness that gets worse when you put pressure on the affected area
- A swollen vein that feels like a tough "cord" under your skin
- Pain when flexing your ankle (keep in mind that thrombophlebitis can happen in other parts of the body, but it usually happens in the legs)
- A swollen foot or ankle
If you have any of these symptoms, see your doctor right away.
When to call 911
These symptoms require immediate medical help:
- One leg seems warmer than the other or is swollen, red, painful, or irritated
- The affected limb becomes pale or cold, or you start feeling chills and fever
- Sudden coughing, which may bring up blood
- Sharp chest pain or chest tightness
- Pain in your shoulder, arm, back, or jaw
- Rapid breathing or shortness of breath
- Pain when you breathe
- Severe lightheadedness
- Fast heartbeat
Thrombophlebitis Causes
First, a blood clot forms. This can be the result of several things. Most often, it’s caused by blood not moving the way it should through the leg veins. This can happen because of:
Long-term bed rest. Your doctor might order this after a major illness or surgery.
Sitting for a long time. This can happen on long trips by car or plane, or in some other place where you can’t stretch your legs.
Varicose veins. They cause your blood vessels to stretch too much. This allows blood to pool in the vessel instead of flowing straight through in one direction. This can lead to blood clots.
Thrombophlebitis Risk Factors
Anyone with poor circulation in their legs may be more likely to have this condition. This could include those who may get thrombophlebitis during or after pregnancy. People who’ve been kept in the hospital on an IV are at risk, too. Hospital staffers try to lower this risk by changing the spots where IV lines are placed in the body.
Other things that raise your chances of having this condition include:
- Certain cancers
- Use of the hormone estrogen for birth control or hormone replacement
- Being over age 60
- Obesity
- Smoking
- A family or personal history of blood clots
- Catheters placed in the central veins of the arm or leg
- Anyone who has a hypercoagulable state
- If you've had trauma
- If you've had surgery and are immobilized, or are immobile for another reason
Thrombophlebitis Diagnosis
The doctor will start by asking about your symptoms and taking a look at veins near the surface of your skin. They’ll do a physical exam. They also may order blood and circulation tests, or imaging exams such as a CT scan or MRI. Other tests might include:
Duplex ultrasound. This painless imaging test doesn’t have radiation the way an X-ray does. It uses sound waves to create a picture. The doctor spreads warm gel on your skin and then rubs a wand over the area where they think the clot is. The wand sends sound waves into your body. The echoes go to a computer, which makes pictures of your blood vessels.
A radiologist will review the images and send a report to your primary care doctor or to the doctor who requested the ultrasound.
D-dimer test. This is a blood test to look for a protein, called D-dimer, that’s made when a blood clot breaks down. Your doctor will order this test if they think you’ve got a dangerous clot, such as a deep vein thrombosis (DVT) or pulmonary embolism (PE).
If your D-dimer level is high, it could mean a clot is breaking down. If your results are negative, it means you probably don’t have a clot. But a positive result doesn’t mean you have a clot. Your doctor will need to order imaging studies to visualize the clot.
MR venography and CT venography. If the results of your ultrasound aren’t clear, your doctor will use these imaging studies to confirm the presence of a clot. They will inject a dye into your vein, and the image will show up on an X-ray. Possible side effects include pain and an allergic reaction to the dye.
CT scan. If your doctor is concerned that a deep vein clot has moved to your lung, they might order this test to get a better image.
Thrombophlebitis Treatment
Most cases of thrombophlebitis in the shallow veins begin to go away by themselves in a week or two. But on rare occasions, these blocked veins can lead to infection. They can even cause tissue damage from the loss of healthy circulation.
If you need treatment, your doctor probably will give you something to ease swelling and pain. They may recommend that you keep your leg raised or take over-the-counter aspirin or ibuprofen. They also might suggest you apply heat to the affected leg or arm for 15 to 30 minutes, two to three times daily.
Antibiotics. You might get them if poor circulation leads to an infection.
Blood thinners. These medications are usually reserved for thrombosis with a high risk of embolization to the lungs or brain. Deep vein thrombosis requires anticoagulation for this reason. You can give yourself enoxaparin (Lovenox) at home through shots under your skin. They help keep the clot from getting bigger. You also may have to take an oral drug such as warfarin (Coumadin) for several months or longer to keep clots from coming back. Your doctor will give you regular blood tests to make sure the meds are working. Other blood thinners include direct thrombin inhibitors and factor Xa inhibitors. They include apixaban (Eliquis), dabigatran (Pradaxa), edoxaban (Savaysa), and rivaroxaban (Xarelto).
Compression stockings. After the clot has resolved and you are on blood thinners, you may be advised to wear a compression stocking on the leg that was affected. This reduces the risk of post-thrombotic or post-phlebitic syndrome. The stockings decrease swelling of the leg, which lowers pressure in the veins and reduces the risk of varicose veins.
Filter. This has much more limited use. An inferior vena cava IVC filter is used on people who can not safely take anticoagulation and are at risk for DVTs, which can lead to pulmonary embolism. The vena cava is the main vein in your abdomen. The IVC filter prevents clots in your legs from breaking loose and traveling to your lungs. You’ll need surgery for this treatment. They are ideally removed within three months after placement.
Varicose vein stripping. This can help with veins that cause pain or recurring thrombophlebitis. The doctor makes small cuts to remove a long vein. It doesn’t affect circulation. Veins deeper down can handle more blood.
Thrombophlebitis Complications
They’re rare, but you could have:
Pulmonary embolism. If the clot breaks loose, it could move to your lungs and block an artery. This condition can be life-threatening.
Postphlebitic syndrome. It can show up months or years after DVT. It often causes pain, swelling, and a feeling of heaviness in the affected leg or arm. You might hear it called post-thrombotic syndrome, venous stasis syndrome, or chronic venous insufficiency.
Thrombophlebitis Prevention
Sitting on long drives or flights is a major cause of blood clots. To prevent them:
- Walk around. Get up for a stroll every hour.
- Keep moving. Don’t just sit there. Flex your ankles. Or press your feet against the floor or footrest about 10 times an hour.
- Keep it loose. Don’t wear tight clothing.
- Stay hydrated. Drink plenty of fluids, but avoid alcohol.
- Take blood thinners. If you have had a clot previously or are at high risk for one, blood thinners may be prescribed as a preventative.
Takeaways
When you have thrombophlebitis, a blood clot forms and blocks a vein — or more than one vein. Your leg is the most common spot for this to happen. It may occur in a vein close to the surface of your skin, or it may happen deep within a muscle. Symptoms include pain, swelling, and redness. Thrombophlebitis can be treated with medication, though in rare cases, you might need a type of surgery. The best way to prevent it is to avoid sitting without moving for long periods, such as on plane and car trips.
Thrombophlebitis FAQs
What is thrombophlebitis after IV treatment?
You may need an intravenous line to deliver medicine to your body. But having an IV can raise your risk of developing a clot. Hospital workers can lower your risk by moving your IV to different veins.
What are the symptoms of thrombophlebitis?
Pain, redness, and swelling are indications that you might have a clot. You need immediate medical treatment if you have any of the following:
- Chills or fever
- The affected limb feels cold
- Pain in your chest, back, shoulder, or jaw
- Coughing up blood
- Fast heartbeat
- Shortness of breath
What's the difference between thrombophlebitis and phlebitis?
Phlebitis is any kind of inflammation in a vein. Thrombophlebitis is specifically caused by a blood clot.
