Diagnosis
To diagnose thrombophlebitis, a doctor might ask you about your discomfort and look for affected veins near your skin's surface. You might have an imaging test, like an ultrasound, to check your leg for superficial or deep vein thrombosis. A blood test can show if you have a high level of a substance that dissolves clots. This test can also rule out DVT and show if you're at risk of having thrombophlebitis repeatedly.
To diagnose thrombophlebitis, your doctor will ask you about your discomfort and look for affected veins near your skin's surface. To determine whether you have superficial thrombophlebitis or deep vein thrombosis, your doctor might choose one of these tests:
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Ultrasound. A wandlike device (transducer) moved over the affected area of your leg sends sound waves into your leg. As the sound waves travel through your leg tissue and reflect back, a computer transforms the waves into a moving image on a video screen.
This test can confirm the diagnosis and distinguish between superficial and deep vein thrombosis.
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Blood test. Almost everyone with a blood clot has an elevated blood level of a naturally occurring, clot-dissolving substance called D dimer. But D dimer levels can be elevated in other conditions. So a test for D dimer isn't conclusive, but can indicate the need for further testing.
It's also useful for ruling out deep vein thrombosis (DVT) and for identifying people at risk of developing thrombophlebitis repeatedly.
Treatment
Superficial thrombophlebitis can be treated by applying heat to the painful area and elevating your leg. You may also take drugs to relieve swelling and irritation and wear compression stockings. From there, it usually improves on its own. For superficial and deep vein thrombosis, or DVT, you might take medications that thin the blood and dissolve clots. You may wear compression stockings that are available by prescription to prevent swelling and prevent complications of DVT. If you can't take blood thinners, a filter can be placed into the main vein in your abdomen to keep clots from lodging in your lungs. Sometimes varicose veins are removed with surgery.
For superficial thrombophlebitis, your doctor might recommend applying heat to the painful area, elevating the affected leg, using an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) and possibly wearing compression stockings. The condition usually improves on its own.
Compression stockings
Compression stockings, also called support stockings, press on the legs, improving blood flow. A stocking butler may help with putting on the stockings.
Your doctor might also recommend these treatments for both types of thrombophlebitis:
- Blood-thinning medications. If you have deep vein thrombosis, injection of a blood-thinning (anticoagulant) medication, such as low molecular weight heparin, fondaparinux (Arixtra) or apixaban (Eliquis), can help prevent clots from growing bigger. After the first treatment, you'll likely be told to take warfarin (Jantoven) or rivaroxaban (Xarelto) for several months to keep preventing clot growth. Blood thinners can cause excessive bleeding. Always follow your doctor's instructions carefully.
- Clot-dissolving medications. Treatment with a clot-dissolving drug is called thrombolysis. The medication alteplase (Activase) is used to dissolve blood clots in people with extensive DVT, including those who have a blood clot in the lungs (pulmonary embolism).
- Compression stockings. Prescription-strength compression stockings help prevent swelling and reduce the chances of complications of DVT.
- Vena cava filter. 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. Usually, the filter is removed when it's no longer needed.
- Varicose vein stripping. A surgeon can remove varicose veins that cause pain or recurrent thrombophlebitis. The procedure involves removing a long vein through small incisions. Removing the vein won't affect blood flow in your leg because veins deeper in the leg take care of the increased volumes of blood.
Self care
In addition to medical treatments, self-care measures can help improve thrombophlebitis.
If you have superficial thrombophlebitis:
- Use a warm washcloth to apply heat to the involved area several times daily
- Keep your leg raised when sitting or lying down
- Use a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), if recommended by your doctor
Let your doctor know if you're taking another blood thinner, such as aspirin.
If you have deep vein thrombosis:
- Take prescription blood-thinning medications as directed to prevent complications
- Keep your leg raised when sitting or lying down if it's swollen
- Wear your prescription-strength compression stockings as directed
Preparing for your appointment
If you have time before your appointment, here's some information to help you get ready.
What you can do
Make a list of:
- Your symptoms, including any that may seem unrelated to the reason for your appointment
- Key personal information, including a family history of blood-clotting disorders or long periods of inactivity recently, such as a car or plane trip
- All medications, vitamins or other supplements you take
- Questions to ask your doctor
For thrombophlebitis, basic questions to ask your doctor include:
- What is likely causing my condition?
- What are other possible causes?
- What tests do I need?
- What treatments are available and which do you recommend?
- I have other health conditions. How can I best manage these conditions together?
- Are there dietary or activity restrictions I need to follow?
- Are there brochures or other printed material I can have? What websites do you recommend?
What to expect from your doctor
Your doctor is likely to ask you questions, such as:
- When did your symptoms begin?
- Do you have symptoms all the time, or do they come and go?
- How severe are your symptoms?
- Have you had an injury or surgery within the past three months?
- What, if anything, seems to improve or worsen your symptoms?
