Thrombophlebitis

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Thrombophlebitis
Other namesPhlebitis [1]
Great saphenous vein thrombosis 05091312009.jpg
Ultrasonographic image showing thrombosis of the great saphenous vein.
Specialty Cardiology   OOjs UI icon edit-ltr-progressive.svg
SymptomsSkin redness [1]
Risk factors Smoking, Lupus [1]
Diagnostic method Doppler ultrasound, Venography [1]
TreatmentBlood thinners, Pain medication [1]

Thrombophlebitis is a phlebitis ( inflammation of a vein) related to a thrombus (blood clot). [2] When it occurs repeatedly in different locations, it is known as thrombophlebitis migrans (migratory thrombophlebitis). [3]

Contents

Signs and symptoms

The following symptoms or signs are often associated with thrombophlebitis, although thrombophlebitis is not restricted to the veins of the legs. [1] [4]

Complications

In terms of complications, one of the most serious occurs when the superficial blood clot is associated with a deep vein thrombosis; this can then dislodge, traveling through the heart and occluding the dense capillary network of the lungs This is a pulmonary embolism which can be life-threatening. [5]

Causes

Deep vein thrombosis/ right leg Deep vein thrombosis of the right leg.jpg
Deep vein thrombosis/ right leg

Thrombophlebitis causes include disorders related to increased tendency for blood clotting and reduced speed of blood in the veins such as prolonged immobility; prolonged traveling (sitting) may promote a blood clot leading to thrombophlebitis but this occurs relatively less. High estrogen states such as pregnancy, estrogen replacement therapy, or oral contraceptives are associated with an increased risk of thrombophlebitis. [1] [4] [6]

Specific disorders associated with thrombophlebitis include superficial thrombophlebitis which affects veins near the skin surface, deep vein thrombosis which affects deeper veins, and pulmonary embolism. [7]

Those with familial clotting disorders such as protein S deficiency, protein C deficiency, or factor V Leiden are also at increased risk of thrombophlebitis. Thrombophlebitis can be found in people with vasculitis including Behçet's disease. Thrombophlebitis migrans can be a sign of malignancy – Trousseau sign of malignancy. [8]

Diagnosis

The diagnosis for thrombophlebitis is primarily based on the appearance of the affected area. Frequent checks of the pulse, blood pressure, and temperature may be required. If the cause is not readily identifiable, tests may be performed to determine the cause, including the following: [1] [4]

Prevention

Prevention consists of walking, drinking fluids and if currently hospitalized, changing of IV lines. [1] Walking is especially suggested after a long period seated, particularly when one travels. [9]

Treatment

Ibuprofen (NSAID) Ibuprofen3DanJ.gif
Ibuprofen (NSAID)

In terms of treatment for this condition the individual may be advised to do the following: raise the affected area to decrease swelling, and relieve pressure off of the affected area so it will encounter less pain. In certain circumstances drainage of the clot might be an option. In general, treatment may include the following: [1] [4] [5]

Epidemiology

Thrombophlebitis occurs almost equally between women and men, though males do have a slightly higher possibility. The average age of developing thrombophlebitis, based on analyzed incidents, is 54 for men and 58 for women. [5]

See also

Related Research Articles

Vein blood vessels that carry deoxygenated blood towards the heart (pulmonary vein is a exception)

Veins are blood vessels that carry blood towards the heart. Most veins carry deoxygenated blood from the tissues back to the heart; exceptions are the pulmonary and umbilical veins, both of which carry oxygenated blood to the heart. In contrast to veins, arteries carry blood away from the heart.

Thrombosis vascular disease caused by the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system

Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets (thrombocytes) and fibrin to form a blood clot to prevent blood loss. Even when a blood vessel is not injured, blood clots may form in the body under certain conditions. A clot, or a piece of the clot, that breaks free and begins to travel around the body is known as an embolus.

Thrombus blood clot

A thrombus, colloquially called a blood clot, is the final product of the blood coagulation step in hemostasis. There are two components to a thrombus: aggregated platelets and red blood cells that form a plug, and a mesh of cross-linked fibrin protein. The substance making up a thrombus is sometimes called cruor. A thrombus is a healthy response to injury intended to prevent bleeding, but can be harmful in thrombosis, when clots obstruct blood flow through healthy blood vessels.

Pulmonary embolism Blockage of one or more of the arteries to the lungs typically by a blood clot which has traveled from elsewhere in the body

Pulmonary embolism (PE) is a blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream (embolism). Symptoms of a PE may include shortness of breath, chest pain particularly upon breathing in, and coughing up blood. Symptoms of a blood clot in the leg may also be present, such as a red, warm, swollen, and painful leg. Signs of a PE include low blood oxygen levels, rapid breathing, rapid heart rate, and sometimes a mild fever. Severe cases can lead to passing out, abnormally low blood pressure, and sudden death.

Venous thrombosis blood clot (thrombus) that forms within a vein

A venous thrombus is a blood clot (thrombus) that forms within a vein. Thrombosis is a term for a blood clot occurring inside a blood vessel. A common type of venous thrombosis is a deep vein thrombosis (DVT), which is a blood clot in the deep veins of the leg. If the thrombus breaks off (embolizes) and flows towards the lungs, it can become a pulmonary embolism (PE), a blood clot in the lungs. This combination is called venous thromboembolism.

Factor V Leiden is a variant of human factor V, which causes an increase in blood clotting (hypercoagulability). Due to this mutation, Protein C, an anticoagulant protein which normally inhibits the pro-clotting activity of factor V, is not able to bind normally to Factor V, leading to a hypercoagulable state, i.e., an increased tendency for the patient to form abnormal and potentially harmful blood clots. Factor V Leiden is the most common hereditary hypercoagulability disorder amongst ethnic Europeans. It is named after the Dutch city Leiden, where it was first identified in 1994 by Prof R. Bertina under the direction of Prof P. Reitsma. Despite the increased risk of VTE, people with one copy of this gene have not been found to have shorter lives than the general population.

Deep vein thrombosis Formation of a blood clot (thrombus) in a deep vein

Deep vein thrombosis (DVT) is the formation of a blood clot in a deep vein, most commonly in the legs or pelvis. Symptoms can include pain, swelling, redness, and enlarged veins in the affected area, but some DVTs have no symptoms. The most life-threatening concern with DVT is the potential for a clot to detach, travel through the right side of the heart, and become stuck in arteries that supply blood to the lungs. This is called pulmonary embolism (PE). Both DVT and PE are considered as part of the same overall disease process, which is called venous thromboembolism (VTE). VTE can occur as an isolated DVT or as PE with or without DVT. The most frequent long-term complication is post-thrombotic syndrome, which can cause pain, swelling, a sensation of heaviness, itching, and in severe cases, ulcers. Also, recurrent VTE occurs in about 30% of those in the 10 years following an inital VTE.

Phlebitis or venitis is the inflammation of a vein, usually in the legs. It most commonly occurs in superficial veins. Phlebitis often occurs in conjunction with thrombosis and is then called thrombophlebitis or superficial thrombophlebitis. Unlike deep vein thrombosis, the probability that superficial thrombophlebitis will cause a clot to break up and be transported in pieces to the lung is very low.

Renal vein thrombosis

Renal vein thrombosis (RVT) is the formation of a clot in the vein that drains blood from the kidneys, ultimately leading to a reduction in the drainage of one or both kidneys and the possible migration of the clot to other parts of the body. First described by German pathologist Friedrich Daniel von Recklinghausen in 1861, RVT most commonly affects two subpopulations: newly born infants with blood clotting abnormalities or dehydration and adults with nephrotic syndrome.

This is a shortened version of the ninth chapter of the ICD-10: Diseases of the circulatory system. It covers ICD codes I00 to I99. All versions of the ICD-10, including the most recent one (2019), can be browsed freely on the website of the World Health Organisation (WHO). The ICD-10 can also be downloaded in PDF-form.

Compression stockings Compression garment

Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.

Phlegmasia cerulea dolens

Phlegmasia cerulea dolens is an uncommon severe form of deep venous thrombosis which results from extensive thrombotic occlusion of the major and the collateral veins of an extremity. It is characterized by sudden severe pain, swelling, cyanosis and edema of the affected limb. There is a high risk of massive pulmonary embolism, even under anticoagulation. Foot gangrene may also occur. An underlying malignancy is found in 50% of cases. Usually, it occurs in those afflicted by a life-threatening illness.

The Trousseau sign of malignancy or Trousseau's syndrome is a medical sign involving episodes of vessel inflammation due to blood clot (thrombophlebitis) which are recurrent or appearing in different locations over time. The location of the clot is tender and the clot can be felt as a nodule under the skin. Trousseau's syndrome is a rare variant of venous thromboembolism (VTE) that is characterized by recurrent, migratory thrombosis in superficial veins and in uncommon sites, such as the chest wall and arms. This syndrome is particularly associated with pancreatic, gastric and lung cancer and Trousseau's syndrome can be an early sign of cancer sometimes appearing months to years before the tumor would be otherwise detected. Heparin therapy is recommended to prevent future clots. The Trousseau sign of malignancy should not be confused with the Trousseau sign of latent tetany caused by low levels of calcium in the blood.

Cerebral venous sinus thrombosis presence of acute thrombosis (a blood clot) in the dural venous sinuses, which drain blood from the brain.

Cerebral venous sinus thrombosis (CVST) is the presence of a blood clot in the dural venous sinuses, which drain blood from the brain. Symptoms may include headache, abnormal vision, any of the symptoms of stroke such as weakness of the face and limbs on one side of the body, and seizures.

Chronic venous insufficiency Human disease

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

Phlegmasia alba dolens is part of a spectrum of diseases related to deep vein thrombosis. Historically, it was commonly seen during pregnancy and in mothers who have just given birth. In cases of pregnancy, it is most often seen during the third trimester, resulting from a compression of the left common iliac vein against the pelvic rim by the enlarged uterus. Today, this disease is most commonly related to some form of underlying malignancy. Hypercoagulability is a well-known state that occurs in many cancer states. The incidence of this disease is not well reported.

Superficial thrombophlebitis

Superficial thrombophlebitis is a thrombosis and inflammation of superficial veins which presents as a painful induration with erythema, often in a linear or branching configuration forming cords.

Blood clots are a relatively common occurrence in the general population and are seen in approximately 1-2% of the population by age 60. Typically blood clots develop in the deep veins of the lower extremities, deep vein thrombosis (DVT) or as a blood clot in the lung, pulmonary embolism (PE). A very small number of people who develop blood clots have a more serious and often life-threatening condition, known as Thrombotic Storm (TS). TS is characterized by the development of more than one blood clot in a short period of time. These clots often occur in multiple and sometimes unusual locations in the body and are often difficult to treat. TS may be associated with an existing condition or situation that predisposes a person to blood clots such as injury, infection, or pregnancy. In many cases a risk assessment will identify interventions that will prevent the formation of blood clots.

Superficial vein thrombosis

Superficial vein thrombosis (SVT) is a type blood clot in a vein, which forms in a superficial vein near the surface of the body. Usually there is thrombophlebitis, which is an inflammatory reaction around a thrombosed vein, presenting as a painful induration with redness. SVT itself has limited significance when compared to a deep vein thrombosis (DVT), which occurs deeper in the body at the deep venous system level. However, SVT can lead to serious complications, and is therefore no longer regarded as a benign condition. If the blood clot is too near the saphenofemoral junction there is a higher risk of pulmonary embolism, a potentially life-threatening complication.

Thrombosis prevention

Thrombosis prevention or thromboprophylaxis is medical treatment to prevent the development of thrombosis in those considered at risk for developing thrombosis. Some people are at a higher risk for the formation of blood clots than others. Prevention measures or interventions are usually begun after surgery as people are at higher risk due to immobility.

References

  1. 1 2 3 4 5 6 7 8 9 10 "Thrombophlebitis: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 23 September 2016.
  2. Torpy JM, Burke AE, Glass RM (July 2006). "JAMA patient page. Thrombophlebitis". JAMA . 296 (4): 468. doi: 10.1001/jama.296.4.468 . PMID   16868304.
  3. Jinna, Sruthi; Khoury, John (2020). "Migratory Thrombophlebitis". StatPearls. StatPearls Publishing.
  4. 1 2 3 4 "Thrombophlebitis Clinical Presentation: History, Physical Examination, Causes". emedicine.medscape.com. Retrieved 23 October 2016.
  5. 1 2 3 Raval, P. (1 January 2014). Thrombophlebitis☆. Reference Module in Biomedical Sciences. doi:10.1016/B978-0-12-801238-3.05368-X. ISBN   9780128012383.
  6. Philbrick, John T.; Shumate, Rebecca; Siadaty, Mir S.; Becker, Daniel M. (23 October 2016). "Air Travel and Venous Thromboembolism: A Systematic Review". Journal of General Internal Medicine. 22 (1): 107–114. doi:10.1007/s11606-006-0016-0. ISSN   0884-8734. PMC   1824715 . PMID   17351849.
  7. "Superficial Thrombophlebitis: Background, Pathophysiology, Etiology". eMedicine. Medscape. 12 July 2016. Retrieved 23 October 2016.
  8. Varki, Ajit (15 September 2007). "Trousseau's syndrome: multiple definitions and multiple mechanisms". Blood. 110 (6): 1723–1729. doi:10.1182/blood-2006-10-053736. ISSN   0006-4971. PMC   1976377 . PMID   17496204.
  9. Tamparo, Carol D. (2016). Diseases of the Human Body. F.A. Davis. p. 292. ISBN   9780803657915 . Retrieved 23 October 2016.

Further reading

Classification
D
External resources