II. Epidemiology
- Superficial Venous Thrombosis accounts for 5% of VTE
III. Pathophysiology
- Superficial Venous Thrombosis has the similar risk factors as Venous Thromboembolism (e.g. Virchow's Triad)
- Distribution
- Lower extremity (most common)
- Greater saphenous vein accounts for more than half of events
- Upper Extremity
- See Upper Extremity DVT
- Consider Thoracic Outlet Syndrome in unprovoked upper extremity Superficial Thrombophlebitis
- Lower extremity (most common)
IV. Signs
- Red, tender, warm inflamed region that follows the course of a vein
- Vein may be palpable
- Limb edema
V. Imaging
- Images
-
Doppler Ultrasound
- DVT identified in 25% at time of Superficial Venous Thrombosis diagnosis
- DVT identified in 10% at 3 months after Superficial Venous Thrombosis diagnosis
- Decousus (2010) Ann Intern Med 152:218-24 [PubMed]
VI. Differential Diagnosis
- Deep Vein Thrombosis
- Septic Superficial Thrombophlebitis
- Cellulitis
- Vasculitis
- Venous Insufficiency
- Ascending Lymphangitis
VII. Management: General
- Hot packs locally applied to Thrombophlebitis
-
NSAIDs (e.g. Ibuprofen)
- Contraindicated in Anticoagulation
VIII. Management: Anticoagulation
- Indications
- Proximal superficial clot (upper thigh) especially within 5 cm of deep system or
- Clot >7 cm long in leg (or 5 cm long in arm) or
- Known clotting disorder or
- Lack of improvement after 1 week
- Precautions
- Thrombus within 3 cm of sphenofemoral junction (greater saphenous vein junction with femoral vein)
- Full dose VTE Anticoagulation for 3 months is recommended
- Decision to anticoagulate is nuanced and largely based on expert opinion
- Consider local Consultation with hematology
- Decision to anticoagulate and its duration is based on multiple factors
- Upper or lower extremity
- Provoked (e.g. IV) or unprovoked
- Clot length and distance to proximal end
- Symptoms
- Hypercoagulable State
- Thrombus within 3 cm of sphenofemoral junction (greater saphenous vein junction with femoral vein)
- Management
- Rivaroxaban 10 mg orally daily
- LMWH (e.g. Lovenox) 40 mg daily or
- Fondaparinux 2.5 mg daily or
- Dalteparin 5000 IU daily
- Course
- Duration: 14 to 45 days
- Expert opinion appears to favor 45 day course
- Exceptions
- Full dose VTE Anticoagulation for 3 months if Thrombus within 3 cm of sphenofemoral junction
- Original recommendations were for 14 days
- However, short durations may be too brief to prevent progression or recurrence
- Indications to extend course to longer duration (30 to 45 days)
- Persistently inflamed (red, painful) or
- Close proximity to perforators into the deep system
- Duration: 14 to 45 days
- References
- Scovell in Eidt and Mills (2021) UpToDate, accessed 2/17/2022
IX. Course
- Most Superficial Thrombophlebitis resolves with symptomatic management
- Upper extremity Thrombophlebitis uncommonly progresses to DVT (except in cases of PICC Line Thrombosis)
X. Resources
- Czysz (2022) Superficial Thrombophlebitis, StatPearls, Treasure Island
XI. References
- DeLoughery and Orman in Majoewsky (2012) EM:Rap 12(12): 4-5
- Litin (2017) Cases from Anticoagulation Clinic, Mayo Clinical Reviews, Rochester, MN
- Kearon (2012) Chest 141:419S-94S [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| Definition (CHV) | swelling of a vein caused by a blood clot |
| Definition (NCI_NCI-GLOSS) | Inflammation of a vein that occurs when a blood clot forms. |
| Definition (NCI) | Inflammation of the veins associated with the presence of a thrombus. |
| Definition (MSH) | Inflammation of a vein associated with a blood clot (THROMBUS). |
| Concepts | Disease or Syndrome (T047) |
| MSH | D013924 |
| SnomedCT | 195433004, 64156001 |
| LNC | LA7475-2 |
| English | Thrombophlebitides, THROMBOPHLEBITIS, Thrombophlebitis NOS, Thrombophlebitis, thrombophlebitis, thrombophlebitis (diagnosis), Venous thrombophlebitis, Thrombophlebitis [Disease/Finding], Thrombophlebitis NOS (disorder), Thrombophlebitis (disorder), Thrombophlebitis, NOS |
| French | THROMBOPHLEBITE, Thrombophlébite veineuse, Thrombophlébite SAI, Thrombophlébite, Thrombo-phlébite |
| Portuguese | TROMBOFLEBITE, Tromboflebite NE, Tromboflebite |
| Spanish | TROMBOFLEBITIS, Tromboflebitis venosa, Tromboflebitis NEOM, tromboflebitis, SAI, tromboflebitis, SAI (trastorno), tromboflebitis (trastorno), tromboflebitis, Tromboflebitis |
| German | THROMBOPHLEBITIS, venoese Thrombophlebitis, Thrombophlebitis NNB, Thrombophlebitis |
| Dutch | veneuze tromboflebitis, tromboflebitis NAO, tromboflebitis, Flebitis, trombo-, Tromboflebitis |
| Italian | Tromboflebite venosa, Tromboflebite NAS, Tromboflebite |
| Japanese | 血栓性静脈炎ＮＯＳ, 血栓性静脈炎, ｹｯｾﾝｾｲｼﾞｮｳﾐｬｸｴﾝ, ｹｯｾﾝｾｲｼﾞｮｳﾐｬｸｴﾝNOS |
| Swedish | Tromboflebit |
| Czech | tromboflebitida, Tromboflebitis NOS, Tromboflebitida, zánět povrchové žíly, zánět povrchových žil |
| Finnish | Tromboflebiitti |
| Russian | FLEBIT BELYI BOLEVOI, TROMBOFLEBIT, ТРОМБОФЛЕБИТ, ФЛЕБИТ БЕЛЫЙ БОЛЕВОЙ |
| Croatian | TROMBOFLEBITIS |
| Polish | Zapalenie żyły sinicze, Zapalenie żyły zakrzepowe, Zapalenie żyły biodrowo-udowej zakrzepowe |
| Hungarian | Thrombophlebitis k.m.n., Venás thrombophlebitis, Thrombophlebitis |
| Norwegian | Tromboflebitt |
Ontology: Superficial thrombophlebitis (C1510431)
| Definition (NCI) | Thrombosis and inflammation of a superficial vein of the extremities. Symptoms include red discoloration and warmth of the skin and pain along the affected vein. |
| Definition (NCI_CTCAE) | A disorder characterized by a blood clot and inflammation involving a superficial vein of the extremities. |
| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 234038008, 267363001, 266327006, 155453005, 2477008 |
| English | THROMBOPHLEBITIS SUPERFICIAL, Thrombophlebitis superficial, Superficial Thrombophlebitis, superficial thrombophlebitis, Superficial thrombophlebitis, Superficial thrombophlebitis (disorder), Superficial thrombophlebitis, NOS |
| Italian | Tromboflebite superficiale |
| German | oberflaechliche Thrombophlebitis, THROMBOPHLEBITIS OBERFLAECHLICH, Thrombophlebitis oberflaechlich |
| Japanese | 表在性血栓性静脈炎, ﾋｮｳｻﾞｲｾｲｹｯｾﾝｾｲｼﾞｮｳﾐｬｸｴﾝ |
| French | THROMBOPHLEBITE SUPERFICIELLE, Thrombophlébite superficielle |
| Portuguese | TROMBOFLEBITE SUPERFICIAL, Tromboflebite superficial |
| Spanish | TROMBOFLEBITIS SUPERFICIAL, tromboflebitis superficial (trastorno), tromboflebitis superficial, Tromboflebitis superficial |
| Czech | Povrchová tromboflebitida |
| Hungarian | Felületes thrombophlebitis, Superficialis thrombophlebitis |
| Dutch | oppervlakkige tromboflebitis |
