II. Epidemiology

  1. Superficial Venous Thrombosis accounts for 5% of VTE

III. Pathophysiology

  1. Superficial Venous Thrombosis has the similar risk factors as Venous Thromboembolism (e.g. Virchow's Triad)
    1. See Thromboembolism Risk Factors
  2. Distribution
    1. Lower extremity (most common)
      1. Greater saphenous vein accounts for more than half of events
    2. Upper Extremity
      1. See Upper Extremity DVT
      2. Consider Thoracic Outlet Syndrome in unprovoked upper extremity Superficial Thrombophlebitis

IV. Signs

  1. Red, tender, warm inflamed region that follows the course of a vein
  2. Vein may be palpable
  3. Limb edema

V. Imaging

  1. Images
    1. deepVeins.jpg
  2. Doppler Ultrasound
    1. DVT identified in 25% at time of Superficial Venous Thrombosis diagnosis
    2. DVT identified in 10% at 3 months after Superficial Venous Thrombosis diagnosis
    3. Decousus (2010) Ann Intern Med 152:218-24 [PubMed]

VI. Differential Diagnosis

  1. Deep Vein Thrombosis
  2. Septic Superficial Thrombophlebitis
  3. Cellulitis
  4. Vasculitis
  5. Venous Insufficiency
  6. Ascending Lymphangitis

VII. Management: General

  1. Hot packs locally applied to Thrombophlebitis
  2. NSAIDs (e.g. Ibuprofen)
    1. Contraindicated in Anticoagulation

VIII. Management: Anticoagulation

  1. Indications
    1. Proximal superficial clot (upper thigh) especially within 5 cm of deep system or
    2. Clot >7 cm long in leg (or 5 cm long in arm) or
    3. Known clotting disorder or
    4. Lack of improvement after 1 week
  2. Precautions
    1. Thrombus within 3 cm of sphenofemoral junction (greater saphenous vein junction with femoral vein)
      1. Full dose VTE Anticoagulation for 3 months is recommended
    2. Decision to anticoagulate is nuanced and largely based on expert opinion
      1. Consider local Consultation with hematology
      2. Decision to anticoagulate and its duration is based on multiple factors
        1. Upper or lower extremity
        2. Provoked (e.g. IV) or unprovoked
        3. Clot length and distance to proximal end
        4. Symptoms
        5. Hypercoagulable State
  3. Management
    1. Rivaroxiban 10 mg orally daily
    2. LMWH (e.g. Lovenox) 40 mg daily or
    3. Fondaparinux 2.5 mg daily or
    4. Dalteparin 5000 IU daily
  4. Course
    1. Duration: 14 to 45 days
      1. Expert opinion appears to favor 45 day course
    2. Exceptions
      1. Full dose VTE Anticoagulation for 3 months if Thrombus within 3 cm of sphenofemoral junction
    3. Original recommendations were for 14 days
      1. However, short durations may be too brief to prevent progression or recurrence
      2. Indications to extend course to longer duration (30 to 45 days)
        1. Persistently inflamed (red, painful) or
        2. Close proximity to perforators into the deep system
  5. References
    1. Scovell in Eidt and Mills (2021) UpToDate, accessed 2/17/2022

IX. Course

  1. Most Superficial Thrombophlebitis resolves with symptomatic management
  2. Upper extremity Thrombophlebitis uncommonly progresses to DVT (except in cases of PICC Line Thrombosis)

X. Resources

  1. Czysz (2022) Superficial Thrombophlebitis, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK556017/

XI. References

  1. DeLoughery and Orman in Majoewsky (2012) EM:Rap 12(12): 4-5
  2. Litin (2017) Cases from Anticoagulation Clinic, Mayo Clinical Reviews, Rochester, MN
  3. Kearon (2012) Chest 141:419S-94S [PubMed]

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Related Studies

Ontology: Thrombophlebitis (C0040046)

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, ケッセンセイジョウミャクエン, ケッセンセイジョウミャクエンNOS
Swedish Tromboflebit
Czech tromboflebitida, Tromboflebitis NOS, Tromboflebitida, zánět povrchové žíly, zánět povrchových žil
Finnish Tromboflebiitti
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, ヒョウザイセイケッセンセイジョウミャクエン
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