Deep Vein Thrombosis and Thrombophlebitis

What is thrombophlebitis?

Thrombophlebitis is an inflammation or swelling of a vein associated with a blood clot inside of it.  It can occur in the deep veins, which are the deep, large veins associated with the major arteries, or the superficial veins, which are the visible veins just under the skin.  Thrombophlebitis usually affects the veins in a patient’s lower legs or thighs but could affect veins in the arms or anywhere else in the body. 

What is deep vein thrombosis?

Deep vein thrombosis (DVT) is a type of thrombophlebitis in which a clot has lodged in one of the large, deep veins.  These clots usually form in the legs where they block circulation and can be dangerous if they break off and travel to other parts of the body.  Pulmonary embolism (PE) is a dangerous possibility involving a blood clot that has formed in a deep vein and traveled through the heart and out to the lungs where it lodges in the arteries.

What is superficial thrombophlebitis?

Superficial thrombophlebitis is a condition in which a superficial vein has become inflamed due to a blood clot.  These blood clots are much less dangerous than those in the deep veins because they cannot break off and travel through the heart.  Superficial thrombophlebitis can occur after an intravenous (IV) line or trauma to the vein.  Redness, inflammation, warmth, tenderness, pain, or hardening of the skin near a superficial vein; swelling of the extremity; and fever are among the symptoms of superficial thrombophlebitis.  Usually a temporary condition, superficial thrombophlebitis can recede within one or two weeks.  The treatment options include pain medications, anti-inflammatory drugs, and anticoagulants.  Superficial thrombosis may also be helped by elevating the legs and warm compresses.  Severe cases may require sclerotherapy, surgical stripping, or removal.

What are the causes of deep vein thrombosis?

Long periods of inactivity can decrease blood flow through the leg veins allowing blood to move slowly and pool in a person’s legs and tend to clot.  Paralysis, estrogen therapy, some cancers, and an inherited tendency to form blood clots can cause deep vein thrombosis as well. 

What are the symptoms of deep vein thrombosis?

The symptoms of deep vein thrombosis, which only about one half of people with the condition experience, may include a swollen area, pain, tenderness, discoloration, or redness in an area of the leg.  A clot in the legs may have no symptoms until it breaks off and lodges in the lungs as a pulmonary embolism.  The symptoms of a pulmonary embolism, an immediately dangerous, sometimes fatal condition, may include chest pain with a deep breath and shortness of breath.

What are the dangers of deep vein thrombosis?

Blood clots in the deep veins of the thigh are the most likely to break off and lodge in another part of the body, but any clot in the large veins has the potential to break free.  Pulmonary embolism is the most frequent complication of deep vein thrombosis, but many other complications are possible.  Pulmonary emboli are dangerous because they can block an artery in the lungs, cutting off blood flow to that area.  If a patient has a hole in the wall separating the two sides of the heart, a blood clot may travel from the legs to the right side of the heart, through the hole (defect) to the left side of the heart, and out of the heart to almost any organ in the body.  If it lodges in the coronary arteries, it can cause a heart attack, and if it lodges in the brain, it can cause a stroke.  Doctors refer to a series of uncomfortable complications that may follow DVT as postphlebitic or post-thrombotic syndrome. This syndrome is the result of veins damaged by a long-term obstruction or blood backflow and occurs in greater than one half of patients diagnosed with DVT about a year after their diagnosis.  Postphlebitic syndrome includes leg pain, swelling, fluid retention, discoloration, and ulceration.  Long-term DVT can also damage the valves of leg veins and cause chronic venous insufficiency, a condition in which the leg veins are unable to properly return blood to the heart.

What are the risk factors for deep vein thrombosis?

Some conditions, diseases, drugs, and behavioral factors can increase a person’s risk for deep vein thrombosis.  These include inherited blood clotting disorders; damaged deep veins; decreased blood flow in the legs from prolonged sitting, standing, or immobilization; cancer and cancer treatment; varicose veins; pregnancy; age greater than sixty; obesity; birth control pills or hormone therapy; and having a central venous catheter.

How do doctors find and diagnose deep vein thrombosis?

Doctors can often identify and diagnose deep vein thrombi by the symptoms they produce in a patient and can then use one or a few tests to confirm the diagnosis and better understand the scope of the condition in a particular patient.  A duplex ultrasound, a test that involves bouncing sound waves off blood flowing in a patient’s leg veins, can allow a doctor to make a clear diagnosis.  A venogram can give a doctor similar clarity using x-rays and dye to reveal clots in a patient’s legs.  Some blood tests can show if a patient has a tendency to form blood clots by testing levels of substances linked to clotting conditions.

How do doctors treat deep vein thrombosis?

Treatment for deep vein thrombosis is often necessary to reduce the risk of complications.  Blood thinning medications like warfarin pills and heparin injections can help prevent current blood clots from growing and new blood clots from forming.  A patient may need to take thrombin inhibitors in place of heparin.  Thrombolytics can be used when a patient is in immediate danger to quickly dissolve a blood clot.  Some patients may need a vena cava filter to prevent blood clots from moving to the lungs.  These filters can often prevent pulmonary emboli but cannot stop blood clots from forming in the legs and can actually cause clots to form around the filter.  Graduated compression stockings may be necessary for some patients to reduce chronic leg swelling with DVT and keep blood from pooling and clotting.  Most thrombi disappear after treatment, but the condition may recur.