Superficial Thrombophlebitis in Emergency Medicine Treatment & Management

  • Author: Robert G Klever Jr, MD; Chief Editor: David FM Brown, MD   more...
 
Updated: Sep 16, 2010
 

Emergency Department Care

Current treatment options are aimed at resolving symptoms and preventing extension to the deep-venous system. The following treatment options are based on the Cochrane Database of Systematic Reviews article published in 2007 that showed that nonsteroidal anti-inflammatory drugs (NSAIDs) and low-molecular weight heparin (LMWH) are the first options.[7]

  • NSAIDs
    • NSAIDs have similar efficacy as low-molecular weight heparin (LMHW) in reducing the risk of extension of superficial thrombophlebitis into the deep venous system and are often more practical and more easily administered than LMHW.
    • One NSAID has not been shown to be superior in the treatment of superficial thrombophlebitis.
  • LMWH
    • The Cochrane Database of Systematic Reviews article suggested that anticoagulation with LMWH is better in reducing local signs and symptoms, along with reducing propagation to a DVT.[7]
    • In addition, LMWH is useful in preventing the progression of thrombosis and is recommended when there is evidence for deep venous thrombosis.
  • Antibiotics
    • Antibiotics are not routinely indicated for treatment of superficial thrombophlebitis, as the erythema and tenderness is a local inflammatory reaction, not an allergic reaction. However, if suppurative thrombophlebitis could be present, then antibiotics should cover both skin flora and anaerobic organisms, especially if an abscess is present.
    • One should also consider MRSA coverage with vancomycin if their local population warrants this.
  • Local thrombolytics: No adequate studies have been performed on use of local thrombolytics, and they were excluded from the Cochrane Database of Systematic Reviews article. Therefore, at this time, their use is not recommended.

Adjunctive therapy

  • Surgery: Data suggest that surgery may be beneficial with regard to local recurrence and extension of thrombosis, allowing for superior symptomatic relief from pain. It should be reserved for those who are poor candidates for NSAID and LMWH therapy or for those who have recurrent thrombophlebitis.[8]
  • Continued ambulation: Ambulation is important to limit venous stasis and reduce the progression of thrombosis. Recognized causes of venous stasis, such as air travel or extended bed rest, are not recommended in patients with phlebitis of any type.
  • Warm compresses: This is indicated for symptomatic relief. Care should be taken to avoid hot compresses that can lead to skin burning.
  • Compression stockings: Gradient compression stockings are an often-overlooked adjunctive therapy that is both benign and effective. Gradient compression hose are highly elastic stockings that provide a gradient of compression that is highest at the toes (at least 30-40 mm Hg) and gradually decreases to the level of the thigh. This amount of compression reduces capacitive venous volume by approximately 70% and increases the measured velocity of blood flow in the deep veins by a factor of 5 or more. Gradient compression hose also have been shown to increase local and regional intrinsic fibrinolytic activity.
Next

Consultations

An emergency physician with training and experience in vascular ultrasonography may perform duplex ultrasonography, but, most often, it is carried out in the vascular laboratory or the radiology department.

Previous
Proceed to Medication
 
 
Contributor Information and Disclosures
Author

Robert G Klever Jr, MD  Resident Physician, Department of Emergency Medicine, Wayne State University School of Medicine Detroit Receiving Hospital

Robert G Klever Jr, MD is a member of the following medical societies: American College of Emergency Physicians, Emergency Medicine Residents Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Adam J Rosh, MD  Assistant Professor, Department of Emergency Medicine, Detroit Receiving Hospital, Wayne State University School of Medicine

Adam J Rosh, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Samuel M Keim, MD  Associate Professor, Department of Emergency Medicine, University of Arizona College of Medicine

Samuel M Keim, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Public Health Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Eddy S Lang, MDCM, CCFP(EM), CSPQ  Associate Professor, Senior Researcher, Division of Emergency Medicine, Department of Family Medicine, University of Calgary Faculty of Medicine; Assistant Professor, Department of Family Medicine, McGill University Faculty of Medicine, Canada

Eddy S Lang, MDCM, CCFP(EM), CSPQ is a member of the following medical societies: American College of Emergency Physicians, Canadian Association of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

David FM Brown, MD  Associate Professor, Division of Emergency Medicine, Harvard Medical School; Vice Chair, Department of Emergency Medicine, Massachusetts General Hospital

David FM Brown, MD is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Craig F Feied, MD, and Jonathan A Handler, MD, to the development and writing of this article.

References

  1. Verlato F, Zucchetta P, Prandoni P, et al. An unexpectedly high rate of pulmonary embolism in patients with superficial thrombophlebitis of the thigh. J Vasc Surg. Dec 1999;30(6):1113-5. [Medline].

  2. Wichers IM, Di Nisio M, Buller HR, Middeldorp S. Treatment of superficial vein thrombosis to prevent deep vein thrombosis and pulmonary embolism: a systematic review. Haematologica. May 2005;90(5):672-7. [Medline].

  3. Rosendaal FR, Helmerhorst FM, Vandenbroucke JP. Oral contraceptives, hormone replacement therapy and thrombosis. Thromb Haemost. Jul 2001;86(1):112-23. [Medline].

  4. Kim J, Richards S, Kent PJ. Clinical examination of varicose veins--a validation study. Ann R Coll Surg Engl. May 2000;82(3):171-5. [Medline].

  5. Gillet JL, Ffrench P, Hanss M, Allaert FA, Chleir F. [Predictive value of D-dimer assay in superficial thrombophlebitis of the lower limbs]. J Mal Vasc. Apr 2007;32(2):90-5. [Medline].

  6. Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. Br Med J (Clin Res Ed). Mar 8 1986;292(6521):658-9. [Medline].

  7. Di Nisio M, Wichers IM, Middeldorp S. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev. Apr 18 2007;CD004982. [Medline].

  8. Quenet S, Laporte S, Decousus H, Leizorovicz A, Epinat M, Mismetti P. Factors predictive of venous thrombotic complications in patients with isolated superficial vein thrombosis. J Vasc Surg. Nov 2003;38(5):944-9. [Medline].

  9. Ascher E, Hanson JN, Salles-Cunha S, Hingorani A. Lesser saphenous vein thrombophlebitis: its natural history and implications for management. Vasc Endovascular Surg. Nov-Dec 2003;37(6):421-7. [Medline].

  10. de Godoy JM, Braile DM. Protein S deficiency in repetitive superficial thrombophlebitis. Clin Appl Thromb Hemost. Jan 2003;9(1):61-2. [Medline].

  11. De Maeseneer MG. Superficial thrombophlebitis of the lower limb: practical recommendations for diagnosis and treatment. Acta Chir Belg. Apr 2005;105(2):145-7. [Medline].

  12. Feied CF. Pulmonary chest pain, cor pulmonale and pulmonary embolism. In: Gibler, Aufderheide, eds. Emergency Cardiac Care. Vol 1. ed. Mosby-Year Book; 1994:243-303.

  13. Feied CF. Pulmonary embolism. In: Rosen P, Barkin RM, eds. Emergency Medicine Principles and Practice. 4th ed. Mosby-Year Book; 1998:3.

  14. Feied CF. Peripheral venous disease. In: Rosen P, Barkin RM, eds. Emergency Medicine Principles and Practice. 4th ed. Mosby-Year Book; 1998:3.

  15. Schonauer V, Kyrle PA, Weltermann A, et al. Superficial thrombophlebitis and risk for recurrent venous thromboembolism. J Vasc Surg. Apr 2003;37(4):834-8. [Medline].

  16. Unno N, Mitsuoka H, Uchiyama T, et al. Superficial thrombophlebitis of the lower limbs in patients with varicose veins. Surg Today. 2002;32(5):397-401. [Medline].

 
Previous
Next
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.