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Treatments and drugs
By Mayo Clinic staffIf thrombophlebitis occurs in a vein just under your skin, your doctor may recommend self-care steps that include applying heat to the painful area, elevating the affected leg and using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID). The condition usually doesn't require hospitalization and improves within a week or two.
Your doctor may also recommend these treatments for thrombophlebitis, including deep vein thrombosis:
- Blood-thinning medications. If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as heparin, will prevent clots from enlarging. After the heparin treatment, taking the anticoagulant warfarin (Coumadin) for several months continues to prevent clots from enlarging. If your doctor prescribes warfarin, follow the directions for taking the medication carefully. Warfarin is a powerful medication that can cause dangerous side effects, such as excessive bleeding. Dabigatran (Pradaxa) is a newer blood-thinning option that is taken orally and may have less risk of bleeding.
- Clot-dissolving medications. This type of treatment is known as thrombolysis. These medications, such as alteplase (Activase), dissolve blood clots and are used for extensive deep vein thrombosis or in some cases of deep vein thrombosis that also includes a blood clot in the lungs (pulmonary embolus).
- Support stockings. These help prevent recurrent swelling and reduce the chances of complications of deep vein thrombosis. Your doctor may recommend prescription-strength support hose.
- Filter. In some instances, especially if you can't take blood thinners, a filter may be inserted into the main vein in your abdomen (vena cava) to prevent clots that break loose in leg veins from lodging in your lungs. Typically, the filter remains implanted permanently. This procedure usually doesn't require you to stay in the hospital.
- Varicose vein stripping. Your doctor can surgically remove varicose veins that cause pain or recurrent thrombophlebitis in a procedure called varicose vein stripping. This procedure, typically done on an outpatient basis, involves removing a long vein through small incisions. Removing the vein won't affect circulation in your leg because veins deeper in the leg take care of the increased volumes of blood. This procedure may also be done for cosmetic reasons. After vein stripping, your doctor may recommend that you wear compression stockings as well.
- Clot removal or bypass. Sometimes, surgery is necessary to remove a clot blocking a vein in your pelvis or abdomen. To treat a persistently blocked vein, your doctor may recommend surgery to bypass the vein, or a nonsurgical procedure called angioplasty to open up the vein. Once angioplasty has opened up the vein, your doctor inserts a small wire mesh tube (stent) to keep the vein open. After surgery, you may still need to take blood-thinning medication.
References
- Torpy JM, et al. Thrombophlebitis. Journal of the American Medical Association. 2008;300:1718.
- Deep vein thrombosis. National Heart, Lung, and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/Dvt/DVT_All.html. Accessed Nov. 3, 2010.
- Fernandez L, et al. Superficial thrombophlebitis of the lower extremity. http://www.uptodate.com/home/index.html. Accessed Nov. 2, 2010.
- Rodriguez-Peralto JL, et al. Superficial thrombophlebitis. Seminars in Cutaneous Medicine & Surgery. 2007;26:71.
- Deep vein thrombosis (DVT). The Merck Manuals: The Merck Manual for Healthcare Professionals. http://www.merck.com/mmpe/sec07/ch081/ch081b.html#sec07-ch081-ch081b-1758. Accessed Nov. 3, 2010.
- Di Nisio M, et al. Treatment for superficial thrombophlebitis of the leg. Cochrane Database of Systematic Reviews. 2007:CD004982.
- Grogan M (expert opinion). Mayo Clinic, Rochester, Minn. Nov. 18, 2010.
- Pradaxa (prescribing information). Ridgefield, Conn.: Boehringer Ingelheim Pharmaceuticals, Inc.; 2010. http://bidocs.boehringer-ingelheim.com/BIWebAccess/ViewServlet.ser?docBase=renetnt&folderPath=/Prescribing%20Information/PIs/Pradaxa/Pradaxa.pdf. Nov. 18, 2010.
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