Thrombophlebitis
There is no robust evidence to guide treatment but please consider:
NSAID notes
Please see NSAID page for more
- Use only one NSAID at a time
- Beware asthma, BP, renal or heart disease
- Ibuprofen may reduce positive effects of aspirin in coronary disease
- If at risk of GI bleed (age >65 yrs, Hx PUD, concomitant use of PUD risk medications, prolonged NSAID requirement
- Use paracetamol instead
- Use PPI (e.g. Zoton Fastab MADE IN IRELAND) with standard NSAID dose
- Treat pain with an oral NSAIDs (paracetamol if NSAID intolerant)
- Local heat (warm moist towel)
- Ted stocking may be useful (please note Ankle Brachial Index)
- Limb elevation when resting
- Keep mobile - immobility is definitely not advisable
- Anticoagulation not advisable for superficial thrombophlebitis
- Antibiotics are not indicated unless systemic inflammation, marked local inflammation or skin puncture (e.g. needle). Admit if antibiotics (usually fluclox or a macrolid) are required. More
- IV drug abusers may have unusual infections, including botulism, MRSA and Streptococcus Group A (contact microbiology)
Ted stockings
Arterial disease may develop in people with venous disease. Please check (ankle brachial pressure index) ABPI before prescribing Ted stockings
- ABPI < 0.5 - Compression treatment contraindicated
- ABPI 0.5 - 0.8: Ted stockings generally avoided
- ABPI > 0.8: Teds safe
ABPI value |
Interpretation |
|---|---|
> 1.2 |
Abnormal. Vessel hardening from PVD |
1.0 - 1.2 |
Normal range |
0.9 - 1.0 |
Acceptable |
0.8 - 0.9 |
Some arterial disease |
0.5 - 0.8 |
Moderate arterial disease |
< 0.5 |
Severe arterial disease |
Admit if
- Systemically unwell
- Suppurative thrombophlebitis
- DVT
- Chest pain or dyspnoea (? PE)
Investigate?
- Thrombophlebitis occurs in a previously normal superficial vein and there is no obvious predisposing cause
- Consider a thrombophilia screen (check with haematology team)
- Migratory or recurrent thrombophlebitis is an indication for a more detailed search for a malignant lesion, or Behçet's syndrome or Buerger's disease.
