Thrombophlebitis



There is no robust evidence to guide treatment but please consider:

  • Treat pain with an oral NSAIDs (paracetamol if NSAID intolerant).
  • Local heat (warm moist towel).
  • Ted stocking may be useful (please note Ankle Brachial Index).
  • Limb elevation when resting.
  • Keep mobile - immobility is definitely not advisable.
  • Anticoagulation for up to 6 weeks (therapeutic dose e.g. Rivaroxaban) is advisable for superficial thrombophlebitis of >5cm long (ACEP) or close fo the saphenofemoral junction (BMJ). Please discuss with patient - therapeutic anticoagulation = ↓ pain and ↓DVTs but ..... low risk DVT anyway and anticoagulation has side effects.
  • Antibiotics are not indicated unless systemic inflammation, marked local inflammation or skin puncture (e.g. needle). Admit if antibiotics (usually Flucloxacillin or a macrolid) are required. More
  • IV drug abusers may have unusual infections, including botulism, MRSA and Streptococcus Group A (contact microbiology).

NSAID notes

Please see NSAID page for more:

  • Use only one NSAID at a time.
  • Beware asthma, BP, renal or heart disease.
  • Ibuprofen may reduce positive effects of aspirin in coronary disease.
  • If at risk of GI bleed (age >65 yr, Hx PUD, concomitant use of PUD risk medications, prolonged NSAID requirement.
    • Use paracetamol instead.
    • Use PPI (e.g. Zoton Fastab MADE IN IRELAND) with standard NSAID dose.

Ted stockings

Arterial disease may develop in people with venous disease. Please check ankle brachial pressure index (ABPI) before prescribing Ted stockings.

  • ABPI < 0.5 - Compression treatment .contraindicated
  • ABPI 0.5 - 0.8: Ted stockings generally avoided.
  • ABPI > 0.8: Teds safe.

ABPI value

Interpretation

> 1.2 Abnormal. Vessel hardening from PVD
1.0 - 1.2 Normal range
0.9 - 1.0 Acceptable
0.8 - 0.9 Some arterial disease
0.5 - 0.8 Moderate arterial disease
< 0.5 Severe arterial disease

Admit if

  • Systemically unwell.
  • Suppurative thrombophlebitis.
  • DVT.
  • Chest pain or dyspnoea (? PE).

Investigate?

  • Thrombophlebitis occurs in a previously normal superficial vein and there is no obvious predisposing cause.
  • Consider a thrombophilia screen (check with haematology team).
  • Migratory or recurrent thrombophlebitis is an indication for a more detailed search for a malignant lesion, or Behet's syndrome or Buerger's disease.


Content by Dr Íomhar O' Sullivan 08/07/2008. Last review Dr. Kanti dasari, Dr ÍOS 17/10/17