Thrombophlebitis

What is thrombophlebitis?

Thrombophlebitis is a condition where you have pain and swelling that happen in relation to a blood clot in one of your veins. It most often happens in veins in your legs but can happen in any vein in your body.

Depending on why it occurs, how severe it is and where it happens, this condition can sometimes indicate a serious medical problem. Minor cases are typically treatable and not dangerous, but early detection and quick treatment are critical to avoid serious complications in more severe cases.

The name thrombophlebitis, pronounced “thromb-oh-fleb-eye-tiss,” breaks down into the following component terms:

• Thrombo-: This comes from the word “thrombus," the medical term for a blood clot that forms inside a blood vessel.
• -phleb-: Having to do with veins.
• -itis: Inflammation.

What happens with this condition?

Instead of being a one-way process, thrombophlebitis is more like the chicken and the egg question. It can happen in either of the following ways:

• Clot before inflammation: This is when a clot forms and causes irritation inside a blood vessel. That irritation leads to the inflammation that is key with thrombophlebitis.
• Inflammation before clot: In other cases, inflammation on the inside of a blood vessel (called phlebitis) can make it possible for a clot to attach to that vessel’s inner wall. That irritation is possible with infections or other conditions that cause swelling or irritation.

Thrombophlebitis is often a localized problem, meaning it commonly affects just one specific place in your body. However, the condition becomes much more serious if it spreads. Depending on where the initial clot forms, it can sometimes progress into dangerous and complicated conditions like deep vein thrombosis (DVT) or pulmonary embolism.

Thrombosis vs. thrombophlebitis: What’s the difference?

There’s a relationship between thrombophlebitis and thrombosis, but they aren’t the same thing. Thrombosis is when a blood clot forms inside one of your blood vessels. That means thrombophlebitis is a related process that sometimes — but not always — happens with thrombosis.

Are there different types of thrombophlebitis?

Thrombophlebitis can happen in any vein in your body. However, several named conditions involve thrombophlebitis that happens for a specific reason or in a certain place. Some of those named conditions include those listed below.

Deep vein thrombosis (DVT)

DVT is when a blood clot happens in a major vein, usually one in your legs. DVT is a serious condition that needs immediate treatment because it can lead to pulmonary embolism, a life-threatening medical emergency.

Superficial thrombophlebitis

Superficial thrombophlebitis happens in smaller veins (or branches of the main veins) in your arms or legs. These are rarely as severe as DVT, but it can be a sign that there’s potential for DVT to happen. Superficial thrombophlebitis can also lead to other serious conditions.

Migratory thrombophlebitis

As the name suggests, migratory thrombophlebitis is a condition that happens when a blood clot and related inflammation affect one vein (or a group of veins) and then migrate (move) onto any other vein(s). In some cases, this can involve multiple clots and may happen in multiple veins in your body at the same time. With this, a blood clot can move from a small vein into a larger one and put you at risk for more serious complications like pulmonary embolism.

Septic thrombophlebitis

This is when thrombophlebitis causes or happens because of an infection. When this kind of infection happens, it can lead to serious conditions, some of which include:

• Lemierre syndrome: This happens when an infection spreads from your upper respiratory system to one of your jugular veins.
• Pylephlebitis: This happens when inflammation of the portal veins, which funnels blood from your upper gastrointestinal tract through your liver, leads to an infection.
• Septic embolism: A septic (infected) clot can break free from where it formed and get stuck somewhere else in your body. That can spread the initial infection, block one or more blood vessels or both.

Septic thrombophlebitis is also especially dangerous because it may mean an infection is spreading throughout your body. That can cause sepsis, which is when your immune system dangerously overreacts to an infection spreading through your body. Sepsis is an extremely deadly medical emergency that needs quick diagnosis and rapid treatment.

Who does it affect?

Thrombosis is possible at any age, especially in people with certain health conditions or life circumstances. However, your risk for developing this condition starts to increase at age 45 and will continue to increase as you get older.

How common is this condition?

Depending on the specific type of thrombophlebitis, this condition ranges from rare to relatively common. Perhaps the most common and well-known example of a related condition is deep vein thrombosis. Each year in the United States, there are an estimated 900,000 cases of DVT, resulting in about 60,000-100,000 deaths per year.

What are the symptoms?

Thrombophlebitis almost always involves the following symptoms:

• Swelling. This symptom, which may appear suddenly, is easiest to see in veins closest to your skin. In severe cases, visible swelling is possible even in deeper veins. If there’s more than one clot, there may also be multiple visible bumps at the various locations of those clots. When this happens to an arm or leg, an uncommon (but still possible) symptom is swelling further down your limb.
• Vein changes that you can feel. Veins with this kind of blockage or inflammation will feel more firm than veins normally do. This can involve one or more veins, usually those nearest to the clot.
• Pain or soreness. Thrombophlebitis is usually a painful condition. The area around and over the clot may feel sore, tender or even painful. When the clots are large, happen in smaller blood vessels or if there are multiple clots, the pain can reach severe levels. People often describe the pain as dull or aching.

Other symptoms that can — but don’t always — happen include:

• Color change around the swollen area. The area nearest the clot may appear redder or darker than the surrounding area, similar to a rash or bruise. This is more likely with clots that are stuck in veins that are closer to your skin. However, it may also happen with deeper clots that are larger or cause a more severe blockage.
• Warmth. The area above and immediately around the clot may feel warmer to the touch than areas farther away.

What causes the condition?

Thrombophlebitis can happen for several different reasons. The following may cause blood clots to form or may merely make them more likely.

• Genetic (inherited) conditions. Mutations in your DNA can cause your blood to clot too easily. Some people inherit these mutations from their parents. Genetic conditions like this are often treatable but will be life-long and aren't curable.
• Varicose veins. Bulging, blue or spider-like veins on your legs are a particular risk for thrombophlebitis in the same area.
• Trauma. Injuries to or close to veins can cause inflammation that leads to clot formation.
• Medical procedures and medications. Intravenous (IV) lines and catheters, which are tubes that deliver medications and fluids directly into your veins, can cause clots that lead to thrombophlebitis. Certain kinds of hormone treatments, including some types of birth control, can also increase your risk of blood clots.
• IV drug use. Recreational drugs that you inject are a risk factor for thrombophlebitis. That’s because infections from using needles unsafely or improperly can easily lead to serious infections. Those infections can then cause inflammation that leads to this condition.
• Lack of movement. People who sit for long periods, such as those with desk jobs, may have poor circulation, increasing their risk of thrombosis. This can also happen to people taking long airplane flights or on a trip that involves an extended period in a car or vehicle.
• Conditions or circumstances that otherwise affect clotting. Various potential risk factors include cancer, obesity, lupus and certain blood disorders. People on bed rest or who have paralysis that limits their mobility may also have a higher risk. Smoking is a lifestyle choice that can also increase your risk, and your risk is also higher when you’re dehydrated.
• Being pregnant or recently giving birth. Pregnancy can increase the risk of developing blood clots for several reasons. That risk also doesn’t go away immediately after childbirth.

Is it contagious?

While it sometimes happens because of an infection, thrombophlebitis is not a contagious condition on its own. This also applies to genetic conditions, which pass in DNA from parent to child. These conditions don’t cause thrombophlebitis directly, but they can cause clotting problems that can lead to this condition.

How is it diagnosed?

Healthcare providers usually diagnose thrombophlebitis in a hospital setting, especially in an emergency room. That's because thrombophlebitis has close connections to severe, potentially life-threatening conditions like DVT.

Your provider will diagnose thrombophlebitis based on a combination of a physical exam, imaging tests and lab tests. Combining these various methods is important because a physical examination alone is usually not enough to diagnose thrombophlebitis. Several conditions have similar symptoms, some of which are especially dangerous, which makes imaging and lab tests even more useful — if not critical — in preventing serious complications.

What tests will be done to diagnose this condition?

A variety of tests are possible when healthcare professionals investigate the possibility of thrombophlebitis or any related or similar conditions. These include:

• Physical examination. This is when a provider looks for any visible signs of thrombophlebitis, especially swelling or color changes. They will often palpate (feel) the affected area with their hands, which can help them find signs or symptoms that are not easy to see but very easy to feel. They can also listen to your pulses, especially pulses in your lower legs or feet, with a stethoscope.
• Lab tests. Several different lab tests may help in diagnosing thrombophlebitis, including those that analyze your blood’s clotting ability, look for evidence of existing clots or that can find signs of infection.
• Imaging tests. An important way to diagnose thrombophlebitis is to see the clot causing it. Ultrasound, which uses ultra-high-frequency sound waves like sonar, is one of the more common tests with clot-based blockage conditions. Tests that use X-rays (especially with IV substances that can highlight blockages) are also common.

In rare cases, migratory thrombophlebitis (mentioned above) can be a sign of certain types of cancers, especially cancers in your abdomen. That may lead healthcare providers to run tests that look for those kinds of cancers.

How is it treated, and can it be cured?

In cases where thrombophlebitis happens because of IV or catheter lines, removing that line is usually the first step. Other treatments usually involve the following.

Medications

Several different types of medications can help with the symptoms of thrombophlebitis and resolve the involved clot. These include:

• Pain medications. Because thrombophlebitis can be very painful, controlling that pain is usually one of the top priorities. This often involves milder drugs, like acetaminophen (Tyelonol®) or non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen. If the pain is more severe, providers may prescribe stronger medications.
• Blood thinners. By definition, thrombophlebitis involves at least one blood clot. However, where there’s one, there’s a risk for more to form. To prevent more clots from forming, especially clots that might cause a life-threatening condition like a pulmonary embolism, healthcare providers will often give you blood thinners. However, if the blood clot is in a small vein, you may not require treatment with blood thinners.
• Thrombolytic drugs. Commonly known as clot-busting drugs, these medications actively break down existing clots. These may be given through an IV or delivered directly to the clot using catheters placed in your blood vessels.
• Antibiotics. In cases where thrombophlebitis involves an infection, antibiotic medications are essential. Antibiotics can prevent an infection from spreading throughout your body and causing sepsis.

Surgery, catheter-based or other types of procedures

In rarer cases, surgery is the best option to help treat severe thrombophlebitis (especially in your legs). Surgery can involve one or more of the following procedures:

• Mechanical thrombectomy. This may be done with small incisions that allow your surgeon to physically remove the blood clot from your vein. Another technique involves catheters inserted into your vein that are able to suck out the blood clot.
• Vein removal. Just like the name sounds, this involves removing the problem vein. During this procedure, your surgeon makes a few small incisions (cuts) in the affected area. Those incisions are how your surgeon can access the damaged vein, disconnect it from your circulatory system and remove it.
• Vein stripping. This is a type of vein removal, but it involves a very specific method. During vein stripping, your surgeon makes a few small cuts to access the problem vein and disconnect it from the rest of your circulatory system. They then insert a small wire, which fits snugly inside your vein, down to the far end. Once it's to the end, they can pull on the wire, and the vein comes out with it (much like putting your hand inside a sock and pulling it inside out).
• Bypass. In some cases, a vein with damage from thrombophlebitis may not have proper blood flow through it. A way to help that is by taking another section of blood vessel from elsewhere in your body and using it to craft a new bypass vessel — which acts as a detour around the narrow area — restoring proper blood flow.
• Sclerotherapy. This is when a healthcare provider, usually a surgeon or other specialist, injects a special solution into the affected vein, causing that vein to seal shut. Closing off those problem areas can keep them from developing clots altogether.
• Catheter-based procedures. Healthcare providers can use these procedures to widen a narrower area of an affected vein. They can also use it for ablations, which are procedures that use heat to intentionally form scar tissue, keeping blood flow out of problem areas.

Wearable compression items

Your healthcare provider may instruct you to wear compression items or clothing. These items, such as socks, stockings or wrappings/bandages, put consistent (but light) pressure on certain parts of your body. That pressure can help prevent new clots from forming and ease the pain and swelling from any previous clot(s).

Possible side effects or complications from treatment

The complications and side effects that are possible with thrombophlebitis treatments can take many forms. Your healthcare provider is the best person to tell you what risks are most likely with your particular case and what you can do to minimize the risks.

How can I take care of myself/manage my symptoms?

In many cases, the treatments mentioned before aren’t necessary. In those cases, your healthcare provider will likely recommend supportive treatments. These include:

• Pain medications. These often include over-the-counter pain medications like NSAIDs.
• Warmth. Items like warm compresses can also help ease the pain from this condition.
• Elevation. If the affected area is in one of your limbs, especially a leg, propping that limb up can help ease swelling and pain.
• Compression. As mentioned before under treatments, wearable compression items can help with the symptoms of existing clots or prevent new ones from happening.

How soon after treatment will I feel better, and how long does it take to recover?

The severity of your case and the treatments you receive determine when you feel better and how long it takes you to recover. In general, you should start to feel better while your symptoms are being treated, especially with medications that treat pain. Most people recover from thrombophlebitis within days, but some may need a little longer (especially if they had complications, the clot was in a critical location or they needed surgery).

How can I prevent this?

The key to preventing thrombophlebitis is knowing you’re at risk for a clot to happen. If you know this, your healthcare provider can prescribe medications like blood thinners, which can stop a clot from forming in the first place.

Unfortunately, many potential factors can make prevention difficult or even impossible. One reason is not knowing you have a health condition (genetic or otherwise) that causes blood clots. Another example is when the clot is a rare complication of a common life circumstance, such as pregnancy.

How can I reduce my risk?

There are several things you can do to reduce your risk of developing a clot and thrombophlebitis. The most important thing is to minimize or eliminate any risk factors that you can. The ones you can impact the most tend to include:

• Tobacco use. Quit using tobacco (including vaping or smokeless tobacco products). If you don’t use tobacco, don’t start.
• IV drug use. If you use injectable (IV) recreational drugs, quitting can significantly reduce your risk for this condition. If you continue to use IV drugs, you may be able to reduce your risk by using needle exchanges or similar programs. They can help you avoid infections from unsafe needle usage.
• Move around. If you sit for long periods for work or during your leisure time, getting up and moving around can make a difference. You can also find ways to get up and move around if you're on a long car ride or on a long airplane ride.
• Take your medications. If your healthcare provider prescribes blood-thinning medications, be sure to take them as instructed. If you stop taking them suddenly, your risk of a clot forming (which can lead to thrombophlebitis) goes up sharply.
• Stay hydrated. Drinking enough fluids can help lower your risk of developing thrombophlebitis.
• Monitor your health. A key way to keep tabs on your health and well-being is getting an annual checkup (often called a physical or wellness visit). This yearly visit is a key opportunity for your healthcare provider to catch health problems before you have any symptoms, including conditions that can increase your risk for clots and thrombophlebitis. If you have conditions that raise your risk, especially clotting disorders or cancer, ask your healthcare provider if you have concerns about this condition.
• Take care of yourself. Eating a healthy diet, staying active (at least 150 minutes a week of moderate-intensity exercise) and maintaining a weight that's healthy for you are all important. They help reduce your chance of developing many serious conditions, including thrombophlebitis.
• Wear support or compression garments. Your healthcare provider can recommend support or compression items that can help prevent blood clots and thrombophlebitis.

What can I expect if I have this condition?

Thrombophlebitis is a serious condition, but it doesn't usually cause problems on its own. It's usually an indicator of clotting problems that can cause more serious conditions, some of which are deadly. If caught early, thrombophlebitis is very treatable, and complications are rare. However, waiting to get this condition diagnosed and treated increases the risk of developing more serious problems.

How long does this condition last?

Thrombophlebitis tends to be a short-lived condition, especially with quick diagnosis and treatment. It’s rare for it to last more than a few hours because the longer you have it, the greater the risk of it becoming a more dangerous problem.

What’s the outlook for this condition?

On its own, thrombophlebitis is usually not dangerous. However, having it does mean you have a much higher risk of developing other conditions like DVT or pulmonary embolism, both of which are medical emergencies. The longer you wait to get treatment, the more dangerous this condition becomes. Waiting also increases the risk of developing long-term problems like chronic pain or scarring in the affected veins (which can limit blood flow).

How do I take care of myself?

If you have conditions that increase your risk for blood clots and thrombophlebitis, the best thing you can do is manage those conditions. That includes:

• Seeing your healthcare provider regularly.
• Taking your medication as your healthcare provider instructs.
• Avoiding behaviors or circumstances that can increase your risk.

When should I call my healthcare provider or seek care?

You should always call your healthcare provider if you have any symptoms of thrombophlebitis. You should also call them if you have a history of thrombophlebitis (or other clotting problems like DVT) and any of your symptoms return or suddenly worsen.

When should I go to the ER?

You should go to the hospital immediately if you have any symptoms of blood flow blockage. If the blockage affects one of your limbs, these symptoms usually include:

• Color change to the affected limb (it will look paler than normal).
• If the skin of the affected area or limb is cooler to the touch than skin in areas that don't seem affected.
• If you have thrombophlebitis or other clot symptoms that suddenly move. This is especially important if you have pain in your chest or shortness of breath either at the same time or shortly after any clot-related symptoms. This can be a symptom of pulmonary embolism, which is a life-threatening medical emergency. If this happens, you should immediately call 911 (or your local emergency services number).

A note from Cleveland Clinic

Thrombophlebitis can be an important warning sign of much more serious conditions. While it isn't usually dangerous on its own, you need to see a medical professional to determine if you have a problem. You might also need to seek emergency care immediately with certain symptoms. With quick diagnosis and treatment, thrombophlebitis is less likely to cause major problems or disrupt your life.