Superficial thrombophlebitis

Background
  • Also known as "superficial venous thrombosis"
  • More likely in patients with varicose veins[1]
  • Associated DVT is rare and usually only occurs at the junctions with deep venous system such as the groin[2]

Types[3]
  • Sterile thrombophlebitis - No infectious association
  • Traumatic superficial thrombophlebitis - Associated with limb injury from blunt trauma, IV catheters or chemical treatment
  • Infection thrombophlebitis - Associated with prolonged IVs and is the only thrombophlebitis to require antibiotics
  • Migratory thrombophlebitis - Recurrent in multiple differing sites and often associated with malignancies

Clinical Features
  • Pain and discoloration of affected area
  • Redness surrounding superficial vein
  • Tender and hard vein on palpation
  • Minimal limb swelling

Differential Diagnosis

Depends on the location

Calf pain

Upper extremity swelling

Groin pain

Evaluation
Point of care ultrasound may support clinical diagnosis as in this case of cephalic vein thrombophlebitis[4]
  • Diagnosis is purely clinical
    • D-dimer has no clinical benefit and only consider DVT evaluation if there is significant limb swelling or location near a deep vein (popliteal/femoral vein)

Management
  • NSAIDs for local pain
  • Antibiotics are only needed if there is an associated cellulitis or obvious infection
  • Little evidence for anticoagulation unless associated with a DVT[5]
  • More recent data suggests this approach[6]:
    • Small clots can be treated with compression, NSAIDs, elevation, follow up within 7-10 days to evaluate for progression
    • Clots > 5 cm should be treated with anticoagulation, enoxaparin 40 mg subQ QD for 45 days
    • Clots within 3 cm of sapheno-femoral junction should be treated like a DVT

Disposition
  • Discharge


See Also

References
  1. Leon L et al. Clinical significance of superficial vein thrombosis. Eur J Vasc Endovasc Surg 2005;29:10-17.
  2. Bergqvist D, Jaroszewski H. Deep vein thrombosis in patients with superficial thrombophlebitis of the leg. BMJ 1986;292:658-9.
  3. Nasr H, Scriven JM. Superficial thrombophlebitis (superficial venous thrombosis). BMJ. 2015;350:h2039. doi:10.1136/bmj.h2039.
  4. http://www.thepocusatlas.com/soft-tissue-vascular/
  5. Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database Syst Rev 2013;4:CD004982.
  6. Cosmi B. Management of superficial vein thrombosis. Journal of thrombosis and haemostasis : JTH. 13(7):1175-83. 2015. PMID: 25903684
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