At the risk of being told again how to use ‘Up to Date’…
For the record, I always feel like I am being a ‘patient advocate’, and not their primary/treating physician, when I make these posts.
I always refer the OP to their PCP and try to enlighten them a bit about things I would think about…
Make sure you have a follow up appointment, Dan!
SUMMARY AND RECOMMENDATIONS
â—Phlebitis and thrombosis of the lower extremity superficial veins are generally benign and self-limited; however, when the larger axial veins, such as the great saphenous or small saphenous veins, are involved (ie, superficial vein thrombosis ) propagation into the deep vein system (ie, deep vein thrombosis ) and even pulmonary embolism (PE) can occur.
â—The diagnosis of phlebitis is primarily clinical, based upon findings of pain, tenderness, induration, and/or erythema along the course of a superficial vein. (See ‘Clinical presentations’ above.)
â—The risk of phlebitis and thrombosis of the lower extremity superficial veins is increased in patients with abnormal coagulation or fibrinolysis, endothelial dysfunction, infection, venous stasis, intravenous therapy, or intravenous drug abuse. (See ‘Risk factors’ above.)
â—Patients should undergo repeat physical examination within 7 to 10 days of their initial diagnosis to look for resolution or progression. Any worsening of clinical symptoms or extension of signs of phlebitis on physical examination should prompt duplex ultrasound. (See ‘Duplex ultrasound’ above and ‘Approach to treatment’ above.)
â—For patients with SVT (ie, axial vein thrombosis), we suggest ultrasound upon initial presentation to rule out the presence of coexistent DVT. Duplex ultrasound should also be performed if there is evidence of clinical extension of thrombophlebitis, lower extremity swelling that is greater than would be expected from thrombophlebitis alone, or the diagnosis is in question. (See ‘Duplex ultrasound’ above.)
â—For all patients diagnosed with phlebitis and thrombosis of the lower extremity superficial veins, supportive measures should be instituted and consist of extremity elevation, warm or cool compresses, compression stockings, and pain management. (See ‘Symptomatic care’ above.)
â—Risk factors for deep vein thrombosis in those with phlebitis and thrombosis of the lower extremity veins include more extensive thrombosis ≥5 cm, anatomic proximity of thrombus to the deep venous system (≤5 cm from the saphenofemoral or saphenopopliteal junction), and medical risk factors for DVT (eg, prior DVT, thrombophilia, malignancy, estrogen therapy). (See ‘Thromboembolism’ above.)
•For patients with phlebitis and thrombosis of the lower extremity veins at low risk for DVT, we suggest oral nonsteroidal anti-inflammatory drugs (NSAIDs) rather than anticoagulation as first-line drug therapy (Grade 2B). (See ‘Approach to treatment’ above and ‘Low risk for thromboembolism’ above.)
•For patients with SVT (not related to endovenous ablation therapy) who are at increased risk for DVT, we suggest anticoagulation for 45 days over supportive care alone (ie, nonsteroidal anti-inflammatory drugs and compression stockings) (Grade 2B). Fondaparinux, low-molecular-weight heparin, unfractionated heparin, direct oral anticoagulants, and vitamin K antagonists appear to be equally effective. A decision to anticoagulate the patient when thrombus approaches the deep venous system at other sites (ie, saphenopopliteal junction, perforator veins) should be individualized; either anticoagulation or serial duplex ultrasound may be appropriate. (See ‘Approach to treatment’ above and ‘Increased risk for thromboembolism’ above.)
â—For thrombus extending into the deep venous system, the patient is treated according to standard protocols for DVT. The treatment of DVT is discussed in detail elsewhere. (See “Overview of the treatment of lower extremity deep vein thrombosis (DVT)”.)
ACKNOWLEDGMENT — The editorial staff at UpToDate would like to acknowledge Leonor Fernandez, MD, who contributed to an earlier version of this topic review
Continued healing!