thinning of blood) may be necessary. This is typically done by injection of low molecular weight heparin (enoxaparin [Lovenox]), or by injection of fondaparinux (Arixtra). It can be done by treatment with therapeutic dosages of unfractionated heparin (usually in the form of an intravenous drip), followed by oral anti-coagulation with warfarin (Coumadin) for about 3 to 6 months. Newer anticoagulants may replace Coumadin in certain circumstances.
Patients with extensive deep vein thrombosis (DVT) may be appropriately treated with catheter-directed thrombolysis in selected cases, but will still require maintenance anticoagulation for 3 to 6 months.
Selected patients with DVT may require placement of inferior vena cava filters to help prevent pulmonary embolus. In a subset of patients, it may be appropriate to remove the filter at a future date.
Recovery of symptoms from superficial phlebitis can last a few weeks. A thrombophlebitis may take weeks to months to recover.
What are the complications of phlebitis?
Complications of phlebitis may include local infection and abscess formation, clot formation, and progression to a deep venous thrombosis and pulmonary embolism. When pronounced deep venous thrombophlebitis has seriously damaged the leg veins, this can lead to post-phlebitic syndrome. Post-phlebitic syndrome is characterized by chronic swelling of the involved leg and can be associated with leg pain, discoloration, and ulcers.
Can phlebitis be prevented?
Simple measures can be taken to prevent phlebitis, although, sometimes it cannot be avoided.
Preventive measures of phlebitis include:
- early mobilization after surgery,
- leg exercises during a long car travel or airplane ride,
- good nursing hygiene and prompt removal of intravenous catheters, and
- smoking cessation.
Compression stockings are required in many patients after an episode of phlebitis, especially deep venous phlebitis. These, and other measures, reduce post-phlebitic swelling and the risk of recurrent phlebitis. In most hospitalized patients who have limited mobility or have had recent orthopedic surgery, a low dose of blood thinners (heparin, fondaparinux, enoxaparin [Lovenox] or other agents ) may be injected routinely in order to prevent blood clot formation by keeping the blood relatively thin. This preventive dose is generally lower than the doses used for treating existing blood clots. A widely used alternative is the use of intermittent compression garments on the extremities during periods of high risk.
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