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Superficial Thrombophlebitis

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Superficial Thrombophlebitis, Thrombophlebitis, Superficial Venous Thrombosis

  • Differential Diagnosis
  1. Deep Vein Thrombosis
  2. Septic Superficial Thrombophlebitis
  • 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]
  • Management
  • General
  1. Hot packs locally applied to Thrombophlebitis
  2. NSAIDs (e.g. Ibuprofen)
  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. Management
    1. LMWH (e.g. Lovenox) 40 mg daily or
    2. Fondaparinux 2.5 mg daily or
    3. Dalteparin 5000 IU daily
  3. Course
    1. Typical: 14 days
    2. Indications to extend to 30-45 days
      1. Persistently inflamed (red, painful) or
      2. Close proximity to perforators into the deep system
  • Course
  1. Most Superficial Thrombophlebitis resolves with symptomatic management
  2. Upper extremity Thrombophlebitis uncommonly progresses to DVT (except in cases of PICC Line Thrombosis)
  • 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]