Both deep vein thrombosis (DVT) and thrombophlebitis are vascular conditions in which the veins become inflamed and blood clots form inside. These conditions almost always develop in the veins in the legs, but occasionally occur in the arms or, more rarely, other parts of the body. Thrombophlebitis occurs in the veins close to the skin (the superficial veins), while DVT occurs in the deep veins (those farther below the skin surface).
The most significant danger for people with DVT is a pulmonary embolism, an infrequent but potentially fatal complication. A pulmonary embolism occurs when part of a blood clot breaks off, travels through the veins to the heart, and from there into the pulmonary arteries, which supply the lungs with blood. The clot can cut off the lung's blood supply, causing shortness of breath, chest pain, and other symptoms.
DVT can also cause post-thrombotic syndrome, a condition in which the veins are permanently damaged. Patients with post-thrombotic syndrome develop varicose veins, pain, swelling, and, in some cases, skin ulcers.
Thrombophlebitis is generally caused by irritation to the lining of the vein from, for example, prolonged intravenous injection of medications or infection. There is a very small risk of the blood clot traveling from the superficial veins into the deeper veins, but serious complications due to thrombophlebitis are extremely rare.
Risk Factors and Symptoms
People with an elevated risk of developing DVT include those who:
- have a history of prior DVT
- are on prolonged bed rest
- have cancer
- have had major surgery
- have a family history of blood clots or a clotting disorder
DVT is also linked to pregnancy, obesity, severe infections, recent major illness, or conditions in which the blood is thicker than normal. The most common symptoms of DVT are swelling of the leg, pain while walking or standing, and redness of the skin on the leg. Some people with DVT also experience pain when the foot is bent upward.
Thrombophlebitis often causes redness that can be seen over the area of the affected vein. The vein may also feel hard and thick, like a piece of rope. Some people experience swelling of the extremity and heat or pain over the vein. These symptoms are sometimes accompanied by fever if the vein is infected.
Doctors diagnose DVT with the use of ultrasound scanning, which can reveal the size and location of a DVT. Doctors may also use ultrasound to diagnose thrombophlebitis.
Treatment
Medical Management
To treat DVT, doctors often use blood-thinning medications to help prevent blood clots already present from growing and to inhibit new ones from forming. Blood thinners also help to stabilize the blood clot and prevent it from breaking off and traveling to other parts of the body. Doctors may also recommend bed rest, with elevation of the extremity for a few days, and have patients wear an elastic bandage or compression stocking on the affected extremity for several months.
Treatment for thrombophlebitis generally involves self-care techniques such as applying heat, and rest and elevation of the area. Non-steroidal anti-inflammatory medications such as ibuprofen may be helpful, and antibiotics may be prescribed if signs of infection are present.
Minimally Invasive Procedures – "Lysis" Therapies
Patients treated with blood thinners (such as heparin, Lovenox, or warfarin) alone are still at risk for developing post-thrombotic syndrome. Therefore, vascular specialists have developed techniques to actively remove a clot from the deep venous system. To do so, they access a deep vein behind the knee or at the groin through a small (about 1 cm) incision. They then insert a catheter through the vein, through which they introduce devices that simultaneously break up the clot mechanically and deliver clot-busting medication (tissue plasminogen activator, or tPA). The procedure has a high technical success rate of re-establishing adequate blood flow in clogged veins.
Assessment Program
NewYork-Presbyterian Hospital features a hospital-wide initiative to reduce the incidence of DVT, which, along with pulmonary embolism, is the number one cause of preventable hospital death. Vascular specialists assess DVT risk among all patients admitted to the hospital, using a risk assessment tool that is now part of the patient electronic medical record system. Patients who are found to be at risk of DVT receive DVT prophylaxis (such as heparin, low molecular-weight heparin, or Coumadin). Patients and their caregivers also receive literature and information about DVT and its prevention.