Superficial 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 (10mg od dose Rivaroxaban off license indication) is advisable for superficial thrombophlebitis of >5cm long (ACEP) or close to 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. BNF
IV drug abusers may have unusual infections, including botulism, MRSA and Streptococcus Group A (contact microbiology)

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 meds, prolonged NSAID requirement):
- Use paracetamol instead
- Use PPI (e.g. Zoton Fastab [IRISH made]) with standard NSAID dose

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

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

Thrombophlebitis occurs in a previously normal superficial vein and there is no obvious predisposing cause
Consider a thrombophilia screen. Please check with haematology team as this is rarely indicated in ED (presence of an acute clot interferes with results)
Migratory or recurrent thrombophlebitis is an indication for a more detailed search for a malignant lesion, or Behcet's syndrome or Buerger's disease (again, please check with haematology)