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)

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


  • 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)

Admit CDU if

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

Content by Dr Íomhar O' Sullivan. Last review Dr Kanti Dasari, Dr ÍOS 29/11/22.