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Superficial Thrombophlebitis

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Superficial Thrombophlebitis, Thrombophlebitis, Superficial Venous Thrombosis

  • Epidemiology
  1. Superficial Venous Thrombosis accounts for 5% of VTE
  • 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
  • Signs
  1. Red, tender, warm inflamed region that follows the course of a vein
  2. Vein may be palpable
  3. Limb edema
  • Imaging
  1. 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]
  • Differential Diagnosis
  1. Deep Vein Thrombosis
  2. Septic Superficial Thrombophlebitis
  3. Cellulitis
  4. Vasculitis
  5. Venous Insufficiency
  6. Ascending Lymphangitis
  • Management
  • General
  1. Hot packs locally applied to Thrombophlebitis
  2. NSAIDs (e.g. Ibuprofen)
    1. Contraindicated in 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
  • Course
  1. Most Superficial Thrombophlebitis resolves with symptomatic management
  2. Upper extremity Thrombophlebitis uncommonly progresses to DVT (except in cases of PICC Line Thrombosis)
  • Resources
  1. Czysz (2022) Superficial Thrombophlebitis, StatPearls, Treasure Island
    1. https://www.ncbi.nlm.nih.gov/books/NBK556017/
  • 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]