Superficial Thrombophlebitis
Basics
Description
- Superficial thrombophlebitis is venous inflammation with secondary thrombosis of a superficial vein.
- Most common in the lower extremities (60–80%), but can occur in the upper extremities/neck
- Generally a benign and self-limiting process but can be painful
- Traumatic thrombophlebitis types:
- Injury
- IV catheter related
- Intentional (i.e., sclerotherapy)
- Aseptic thrombophlebitis types:
- Primary hypercoagulable states: disorders with measurable defects in the proteins of the coagulation and/or fibrinolytic systems
- Secondary hypercoagulable states: clinical conditions with a risk of thrombosis (venous stasis, pregnancy)
- Septic (suppurative) thrombophlebitis types:
- Iatrogenic, long-term IV catheter use
- Infectious, mainly syphilis and psittacosis
- Mondor disease
- Rare presentation of groin, penis, or anterior chest/breast veins
- System(s) affected: cardiovascular
- Synonym(s): phlebitis; phlebothrombosis, superficial vein thrombosis (SVT)
Geriatric Considerations
Septic thrombophlebitis is more common; prognosis is poorer.
Pediatric Considerations
Subperiosteal abscesses of adjacent long bone may complicate the disorder.
Pregnancy Considerations
- Associated with increased risk of aseptic superficial thrombophlebitis, especially during postpartum
- As NSAIDs are contraindicated during pregnancy, alternative therapeutic approaches are advised.
Epidemiology
- Predominant age
- Traumatic/IV related has no predominant age/sex.
- Aseptic primary hypercoagulable state
- Childhood to young adult
- Aseptic secondary hypercoagulable state
- Mondor disease: women, ages 21 to 55 years
- Thromboangiitis obliterans onset: ages 20 to 50 years
- Predominant sex
- Suppurative: male = female
- Aseptic
- Spontaneous formation: female (55–70%)
- Mondor: female > male (2:1)
Incidence
- Septic
- Incidence of catheter-related thrombophlebitis is 88/100,000 persons per year.
- Develops in 4–8% if cutdown is performed
- Aseptic primary hypercoagulable state: Antithrombin III and heparin cofactor II deficiency incidence is 50/100,000 persons.
- Aseptic secondary hypercoagulable state
- In pregnancy, 49-fold increased incidence of phlebitis
- Superficial migratory thrombophlebitis in 27% of patients with thromboangiitis obliterans
Prevalence
- Superficial thrombophlebitis is common.
- 1/3 of patients in a medical ICU develop thrombophlebitis that eventually progresses to the deep veins.
Etiology and Pathophysiology
- Similar to deep venous thrombosis; Virchow triad of vessel trauma, stasis, and hypercoagulability (genetic, iatrogenic, or idiopathic)
- Varicose veins play a primary role in etiology of lower extremity phlebitis.
- Mondor disease pathophysiology not completely understood
- Less commonly due to infection (i.e., septic)
- Staphylococcus aureus, Pseudomonas, Klebsiella, Peptostreptococcus sp.
- Candida sp.
- Aseptic primary hypercoagulable state
- Due to inherited disorders of hypercoagulability
- Aseptic secondary hypercoagulable states
- Malignancy (Trousseau syndrome: recurrent migratory thrombophlebitis): most commonly seen in metastatic mucin or adenocarcinomas of the GI tract (pancreas, stomach, colon, and gallbladder), lung, prostate, and ovary
- Pregnancy
- Estrogen-based oral contraceptives
- Behçet, Buerger, or Mondor disease
Genetics
Not applicable other than hypercoagulable states
Risk Factors
- Nonspecific
- Varicose veins
- Immobilization
- Obesity
- Advanced age
- Postoperative states
- History of previous venous thromboembolic event (VTE)
- Traumatic/septic
- IV catheter (plastic > coated)
- Lower extremity IV catheter
- Cutdowns
- Burn patients
- AIDS
- IV drug use
- Aseptic
- Pregnancy
- Cancer, debilitating diseases
- Estrogen-based oral contraceptives
- Surgery, trauma, infection
- Hypercoagulable state (i.e., factor V, protein C, or S deficiency, others)
- Thromboangiitis obliterans: persistent smoking
- Mondor disease
- Breast cancer or breast surgery
General Prevention
- Avoid lower extremity cannulations or IVs.
- Insert catheters under aseptic conditions, secure cannulas, and replace every 3 days.
- Avoid stasis and use usual deep vein thrombosis (DVT) prophylaxis in high-risk patients (i.e., ICU, immobilized).
Commonly Associated Conditions
- Frequently seen with concurrent DVT (6–53%)
- Symptomatic pulmonary embolism can also be seen concurrently (0–10%).
- Both DVT/PE can occur up to 3 months after onset of superficial thrombophlebitis.
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Citation
Domino, Frank J., et al., editors. "Superficial Thrombophlebitis." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2020. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688629/all/Superficial_Thrombophlebitis.
Superficial Thrombophlebitis. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2020. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688629/all/Superficial_Thrombophlebitis. Accessed December 4, 2023.
Superficial Thrombophlebitis. (2020). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (27th ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688629/all/Superficial_Thrombophlebitis
Superficial Thrombophlebitis [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2020. [cited 2023 December 04]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688629/all/Superficial_Thrombophlebitis.
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