Thrombophlebitis

Thrombophlebitis is inflammation of a vein accompanied by thrombosis. It most often involves superficial veins in the legs or arms, but it can affect the deep venous system in deep vein thrombosis. The condition arises when factors from Virchow's triad—venous stasis, endothelial injury, and hypercoagulability—promote thrombus formation along with local inflammation. Risk factors include recent surgery, cancer, pregnancy, estrogen-containing medications, obesity, smoking, prolonged immobilization, and prior venous thrombosis.

Clinical features vary by location. Superficial thrombophlebitis presents with a tender, cordlike vein, redness, and warmth along a superficial vein, commonly near varicose veins. Deep vein thrombosis presents with unilateral leg swelling, pain, warmth, and sometimes erythema; fever can occur. DVT can lead to pulmonary embolism, a life-threatening complication, if the clot travels to the lungs.

Diagnosis typically relies on duplex ultrasonography to detect a thrombus. D-dimer testing may help in low-probability cases. In uncertain situations, venography or magnetic resonance imaging can be used. The overall approach depends on the location and extent of thrombosis.

Treatment options differ by type. Superficial thrombophlebitis is usually managed with nonsteroidal anti-inflammatory drugs, local heat, leg elevation, and compression; anticoagulation is generally not required unless the thrombosis is proximal, extensive, or progressing toward the deep system. Deep vein thrombosis requires anticoagulation, such as a direct oral anticoagulant or heparin followed by a vitamin K antagonist, for a period typically 3 months or longer based on risk factors. Severe disease or suspected pulmonary embolism may necessitate hospitalization.

Prevention focuses on mobilization after surgery, therapeutic compression stockings, and management of risk factors. The prognosis is excellent for isolated superficial thrombophlebitis but more variable for DVT, with risks including recurrent thrombosis and post-thrombotic syndrome.