Phlebitis

Phlebitis

Definition

Thrombophlebitis is the inflammation of a vein, with blood clots forming inside the vein at the site of inflammation. Thrombophlebitis is also known as phlebitis, phlebothrombosis, and venous thrombosis.

Description

There are two aspects of thrombophlebitis, inflammation of a vein and blood clot formation. If the inflammation component is minor, the disease is usually called venous thrombosis or phlebothrombosis. Thrombophlebitis can occur in both deep veins and superficial veins, but most often occurs in the superficial veins of the extremities (legs and arms). Most cases occur in the legs. When thrombophlebitis occurs in a superficial vein, one that is near the surface of the skin and is visible to the eye, the disease is called superficial thrombophlebitis. Any form of injury to a blood vessel can result in thrombophlebitis. In the case of superficial thrombophlebitis, the blood clot usually attaches firmly to the wall of the affected blood vein. Since superficial veins do not have muscles that massage the veins and help the blood to circulate, blood clots in superficial veins tend to remain where they form and seldom break loose. When thrombophlebitis occurs in a deep vein, a vein that runs deep within muscle tissue, it is called deep venous thrombosis. Deep venous thrombosis presents the threat of producing blood clots that will break loose to form emboli. Emboli are clumps of cells that are carried by the circulation to other tissues where they can lodge and block the blood supply. Emboli typically come to rest in the lungs and cause tissue damage that can sometimes be serious or fatal.

Causes & symptoms

The main symptoms of phlebitis are tenderness and pain in the area of the affected vein. Redness and/or swelling may also be seen. In the case of deep venous thrombosis, there is more swelling than is caused by superficial thrombophlebitis, and the patient may experience muscle stiffness in the affected area. There are many causes of thrombophlebitis. The main causes can be grouped into three categories: injury to veins, increased blood clotting, and blood stasis. When blood veins are damaged, collagen in the vein wall is exposed. Platelets respond to collagen by initiating the clotting process. Damage to a vein can occur as a consequence of in-dwelling catheters, trauma, infection, Buerger's disease, or the injection of irritating substances. Increased tendency of the blood to clot can be caused by malignant tumors, genetic disorders, high-fat diets , and oral contraceptives. Stasis, in which the blood clots due to decreased blood flow in an area, can happen following surgery, as a consequence of varicose veins , as a complication of postpartum states, and following prolonged bed rest. In the case of prolonged bed rest, blood clots form because of inactivity, allowing blood to move sluggishly and stagnate (collect) in the veins. Stasis can lead to blood clots. These clots (also called emboli) are sometimes released when the patient stands up and resumes activity. Emboli can present a problem if they lodge in vital organs. In the case of postpartum patients, a fever developing four to 10 days after delivery may indicate thrombophlebitis. It is also known that thrombophlebitis in some patients involves hereditary factors, including mutations of genes that control the amount of clotting factors in the blood.

Questions have been raised in recent years as to whether frequent long-distance air travel increases the risk of thrombophlebitis in airline pilots and passengers. As of 2001, studies of the effects of long-distance flights on blood circulation in human test subjects have yielded conflicting results.

Diagnosis

In superficial thrombophlebitis, the location of the clot can sometimes be seen by the unaided eye. Blood clots are hard and can usually be detected by a physician using palpation (massage). Deep venous thrombosis requires specialized diagnostic instruments to detect the blood clot. Among the instruments a physician may use are ultrasound and x ray, coupled with dye injection (venogram).

Treatment

While patients have to rely on conventional medicine to resolve major blood clots in the veins, alternative therapies help prevent future blood clots and bring relief from pain due to superficial thrombophlebitis.

Physical therapy

Physical therapy helps prevent blood clots in patients who are temporary bed-ridden after a major surgery or accidents. Physical therapists help patients exercise their arms and legs while they are restricted in bed, use massage to stimulate muscles, and encourage them to regain their mobility as soon as possible.

Nutritional therapy

The following dietary changes may help prevent phlebitis and further vein damage:

• Limit fat intake. Saturated and hydrogenated fats are associated with increased risk of thrombosis and poor blood circulation.
• Eat a heart-healthy, high-fiber diet with emphasis on fruits, vegetables, grains, beans, nuts and seeds, and fish.
• Eat lots of garlic, ginger , onions, and hot pepper. These spices have blood-thinning activity and prevent clot formation.
• Increase consumption of cherries, blueberries, and blackberries. They contain chemicals called proanthocyanidins and anthocyanidins that help improve vein function and keep veins healthy.
• Take nutritional supplements. Supplements that help prevent blood clots and keep veins healthy include B-complex vitamins, especially folic acid (2,500 mg/day), vitamin B₆ (25 mg/day) and vitamin B₁₂ (2 mcg/day); vitamin C (500 - 3,000 mg/day) and vitamin E (800 - 1,200 IU).

Herbal therapy

Several herbs help keep veins healthy and strong and/or prevent blood clots. They include:

• Butcher's broom (Ruscus aculeatus )
• Gingko biloba
• Gotu Kola (Centella asiatica )
• Horse chestnut (Aesculus hippocastanum )
• Bromelain (a natural enzyme found in pineapple that inhibits clot formation therefore preventing thrombophlebitis).

Allopathic treatment

Superficial thrombophlebitis usually resolves without treatment. Application of heat or anti-inflammatory drugs (aspirin or ibuprofen) can help relieve the pain. It can take from several days to several weeks for the clot to resolve and the symptoms to completely disappear. Rarely, anticoagulant drugs may be administered.

Deep venous thrombosis is a serious condition. To prevent pulmonary embolism, anticoagulant drugs are given and the patient's limbs are elevated. The primary objective in treating deep venous thrombosis (DVT) is prevention of a pulmonary embolism. The patient usually is hospitalized during initial treatment. The prescribed anticoagulant drugs limit the ability of blood clots to grow and new clots to form. Sometimes, a drug that dissolves blood clots is administered. Recent advances in drug treatment of DVT include the use of low molecular weight heparin (LMWH), which is safer for use in pregnant women and also allows more patients with DVT to be treated on an outpatient basis.

Surgery may be used to treat DVT if the affected vein is likely to present a long term threat of producing blood clots that will release emboli. The affected veins are either removed or tied off to prevent the release of the blood clots. Tying off superficial blood veins is an outpatient procedure that can be performed with local anesthesia. The patient is capable of immediately resuming normal activities.

Expected results

Superficial thrombophlebitis seldom progresses to a serious medical complication, although non-lethal embolisms may be produced. Deep venous thrombosis may lead to embolism, especially pulmonary embolism. This is a serious consequence of deep venous thrombosis, and is sometimes fatal.

Prevention

To prevent phlebitis, people should eat a high-fiber, heart-healthy diet and engage in regular physical exercises such as walking, bicycling, or running. If temporarily bedridden, they should stretch their arms and legs frequently and try to become mobile as soon as possible.

Resources

BOOKS

Alexander, R.W., R. C. Schlant, and V. Fuster, eds. The Heart, 9th edition. New York: McGraw-Hill, 1998.

Berkow, Robert, ed. Merck Manual of Medical Information. Whitehouse Station, NJ: Merck Research Laboratories, 1997.

Larsen, D.E., ed. Mayo Clinic Family Health Book New York: William Morrow and Company, Inc., 1996.

Murray, Michael T., and Joseph Pizzorno. "Varicose Veins." In Encyclopedia of Natural Medicine, revised 2nd ed. Rocklin, CA: Prima Publishing, 1998.

"Phlebitis." In Prevention's Healing with Vitamins: The Most Effective Vitamin and Mineral Treatment for Everyday Health Problems and Serious Disease-From Allergies and Arthritis to Water Retention and Wrinkles. Emmaus, PA: Rodale Press, Inc., 1996.

"Phlebitis/Venous Thrombosis." In Reader's Digest Guide to Medical Cures & Treatments: A Complete A-to-Z Source-book of Medical Treatments, Alternative Options, and Home Remedies. Canada: Reader's Digest Association, Inc., 1996.

PERIODICALS

Egermayer, Paul. "The 'economy class syndrome': Problems with the assessment of risk factors for venous thromboembolism." Chest 120 (October 2001): 1047-1048.

Evans, A. D. B., and R. V. Johnston. "Venous Thromboembolic Disease in Pilots." Lancet 358 (November 17, 2001): 1734.

Ulutin, T. A., J. Altinisik, H. O. Ates, et al. "Screening of Factor V Leiden (G1691A), Prothrombin G20210A and Protein C Mutations in Thrombosis Patients." American Journal of Human Genetics 69 (October 2001): 430.

Zoler, Mitchel L., and Winnie Anne Imperio. "Drug Update: Outpatient Treatment of Deep Vein Thrombosis." Internal Medicine News 34 (December 1, 2001): 24.

Mai Tran

Rebecca J. Frey, PhD