If you are a frequent flyer in flights for periods of more than 8 hours there are chances for you to be affected by Thrombophlebitis. The inactivity of just sitting in one place for a long time causes this blood clotting inflammatory disease.
Image source: Shutterstock.comThrombophlebitis – Symptoms , Causes, Health Risk And Prevention 1
It may affect any part of the body but typically it affects the veins in the leg. Those who are bedridden for a long time also have more chances of blood clot inflammation or Thrombophlebitis.
Inactivity is cursed by elders for various reasons. But to be inactive in one place sitting idly without any movement could bring in Thrombophlebitis and cause mild to life-threatening ailments.
Image source: Yourveininstitute.comThrombophlebitis – Symptoms , Causes, Health Risk And Prevention 2
“Thrombo” means clot and “phlebitis” means inflammation. The inflammation in the veins due to the solid formation of blood cells that clump together and form a clot is called Thrombophlebitis. When there is swelling or the veins turning red it could be because of Thrombophlebitis.
During a plane or car journey or even in offices sitting for a prolonged time could lead to many illnesses including thrombophlebitis. Hence standing up, stretching, and moving the feet periodically could reduce this risk. Also taking a small walk could promote blood circulation, which discourages the blood cells from sticking together.
1 individual out of 2500-5000 of the population is estimated to be affected by Thrombophlebitis. It increases to 4 % for patients with a past history of thrombosis or blood clotting. It also increases the chances of DVT or deep venous thrombosis affected patients from 26 % to 68 %.
Injury, trauma, and resistance to Protein C are other common causes of Thrombophlebitis. Most cases of it happen in the shallow leg veins and go way in a week. But if it persists beyond that it is better to see the doctor immediately. To know more continue reading till the end.
TYPES OF THROMBOPHLEBITIS:
Depending on the place of occurrence of Thrombophlebitis on the surface of the skin or deeper in between the muscle layers it is classified into three types. They include:
Superficial Thrombophlebitis:
Image source: emsandbox.comThrombophlebitis – Symptoms , Causes, Health Risk And Prevention 3
If the blood circulation slows down because of inactivity it affects more in the legs. This could be also due to gravitation and being the most distant from the pumping of blood from the heart. They mostly appear on the surface of the skin. It is not a serious ailment but could be painful and need treatment if the symptoms persist.
DVT:
DVT or deep vein thrombosis is a blood clot in a vein deep in the body. The most affected part is the lower leg or the thigh. In serious cases, the clot could get loose and travel through the bloodstream through reflux action. When this gets into the artery in the lungs it could affect the blood flow and cause pulmonary embolism. This could damage the lungs and other organs by blocking the blood circulation there. This is a life-threatening disease and needs emergency treatment.
Migratory Thrombophlebitis:
This is also known as Trousseau Syndrome or Thrombophlebitis migrans. When thrombophlebitis occurs repeatedly or when the clot moves around the body this occurs. This is mainly due to underlying cancer or pancreas of the lung.
SYMPTOMS OF THROMBOPHLEBITIS:
The symptoms of thrombophlebitis depend on the type of thrombophlebitis. The symptoms mostly appear on the affected area in the part of the body.
Common symptoms for all types of Thrombophlebitis:
Image source: healthage.comThrombophlebitis – Symptoms , Causes, Health Risk And Prevention 4
The affected area becomes red, warm, swollen and causes irritation of the skin there.
The swollen vein becomes tough like a cord.
Edema or swollen foot or ankle which causes pain when flexing
Pain or tenderness will be confined only to the affected area and becomes worse when pressed
Serious symptoms in case of deep vein thrombosis:
The affected veins will become visibly engorged with erythema or severe redness
The affected leg will be warmer than the other leg and cause more irritation, and, swelling.
The pain will be more diffuse and more common in the lower extremities than elsewhere
The affected limb becomes pale or cold and the patient starts feeling chills and fever
When more than one of the common symptoms occur or it persists for a longer time
CAUSES OF THROMBOPHLEBITIS:
Thrombophlebitis is an issue with the blood circulation or how well or fast the blood moves through the veins. This issue is because of the blood clot which slows down the circulation and in serious cases redirects it back to the lungs. This is because of the blood clot formation which could be due to many causes which include:
Long-term bed rest due to illness or surgery
Sitting for a longer period in a place where the legs couldn’t be stretched
Frequent long flights or car drives of a period of more than 8 hours
Varicose veins in serious conditions could lead to thrombophlebitis
Having a pacemaker in the body
Having a central venous IV line
Having an inherited condition that causes the blood to clot too much than the normal levels
Being overweight or obesity
Being on hormone therapy or a hormone replacement
Taking birth control pills
Smoking
Having a family history of thrombophlebitis
Previously being affected by thrombophlebitis
Neurogenic Heterotopic Ossification after a stroke accompanying a cerebral or spinal insult
Elderly people more than 60 years of age
An injury to a vein
Illicit drug abuse and use of cannabis
Catheters placed in central veins of the arm or leg
High estrogen levels as in the case of pregnancy or due to estrogen replacement therapy
Lupus an autoimmune disease which could damage any part of the body
Protein S deficiency which causes increased blood clots
Protein C, an anticoagulant protein deficiency also causes increased blood clots
Factor V Leiden a variant or a mutated form of human factor V which is one of the several substances that helps blood clot increases blood clotting
Vasculitis which is a group of disorders that destroy blood vessels by inflammation affecting both the arteries and veins
Having certain cancers
COMPLICATIONS DUE TO THROMBOPHLEBITIS:
Superficial thrombophlebitis is less harmful but in case of deep vein thrombosis may cause even life-threatening complications like:
Pulmonary embolism:
When the blood clots become dislodged in the deep vein it could travel to the lungs and block the artery and could even cause death.
Post-Phlebitic Syndrome:
This condition is also known to the post-thrombotic syndrome. This can develop even years after having deep vein thrombosis. This could cause long-lasting disabling pain, swelling and a feeling of heaviness in the affected leg.
PATHOPHYSIOLOGY OF THROMBOPHLEBITIS:
Thrombophlebitis is defined as thrombotic inflammation of a previously healthy superficial vein. The functional changes that occur due to thrombophlebitis include:
Travel-related venous thrombosis:
A study has confirmed that thromboembolism increases 2 fold even after several weeks of stationery travel of more than 4 hours.
Protein C resistance:
In a study conducted nearly 46 % of patients with protein C resistance were prone to be affected by thromboembolism.
Hypercoagulable states:
A study confirmed that 72 % of hypercoagulable state patients are affected. The following are the qualitative and quantitative defects of coagulation factor inhibitors:
Antithrombin deficiency
Protein C deficiency
Protein S deficiency
Heparin Cofactor II deficiency
Tissue factor pathway inhibitor deficiency
Thrombomodulin deficiency
The following increased levels of coagulation factors:
Activated protein C resistance factor V Leiden
Prothrombin gene mutation
Dysfibrinogenemia and hyperfibrinogenemia
Elevated levels of clotting factors VII, VIII, IX, XI, and XII
Inherited factor deficiency:
For patients below 45 years referred for evaluation of venous thrombosis the prevalence of antithrombin III, protein C, and protein S deficiency is approximately 5 % for each. Any genetic alteration in Factor V results in APC or activated protein C resistance which results in one of three patients evaluated of DVT
Pregnancy:
During pregnancy, the protein S levels decrease by nearly 68% and become normal only after 12 weeks of delivery. There are also an increase in procoagulant factors and a reduction in fibrinolytic activity. These all occur to prevent hemorrhage during placental separation. But this could cause superficial thrombophlebitis.
DIAGNOSIS OF THROMBOPHLEBITIS:
In the case of serious and persistent symptoms, it becomes necessary to see a doctor. Doctors conduct a physical examination of the affected area. In the case of superficial thrombophlebitis the affected area will be firm, tender, and, erythematous fibrous cord. In the case of DVT mild to moderated edema, erythema and tenderness will prevail. Pain will be felt more in a lower extremity.
If the appearance and description of the affected area are not sufficient for the doctor to come to a conclusion he may inquire the following questions:
About personal or family history of thrombophlebitis
History of symptoms
For female patients enquires about recurrent abortions and pregnancy
An underlying deficiency of hypercoagulability
About smoking and any drug abuse
Will check if under any hormone therapy
About lifestyle and travel
The doctor will also consider possibilities of Vasculitis, Sickle cell disease, Thalassemia Beta & Alpha and also malignancy. According to the information and the appearance of the affected area, the doctor may suggest taking the following tests to arrive at a conclusion of what type of thrombophlebitis, its severity and if any other parts are affected by it.
Ultrasound testing:
If the doctor suspects a blood clot the first test he recommends is the ultrasound test. By using sound waves it creates an image of the veins. The doctor could diagnose the kind of ailment from the image and prescribe treatment.
Doppler Ultrasound test:
This test will enable the doctor to evaluate the blood flow in the veins. This will precisely give a picture of the blood flow at that moment. If the blood due to some blockage flows slowly it could be ascertained from the Doppler ultrasound.
Venography:
If the doctor is not satisfied with the ultrasound tests he may suggest a venography test. A dye will be injected into the vein. The image is then viewed by an X-ray to ascertain the severity of the ailment. But with venography, there could be side effects due to the dye injection and also pain.
D-dimer test:
The blood is checked for a protein called D-dimer. Blood is taken from the vein with a needle and checked for D-dimer levels. If it is high it means the clot is in the process of breaking down and if it is negative it means there is no clot.
MRA:
MR angiography is a test taken by MRI machine to give a detailed picture of the vein. A dye is injected into the veins and blood vessels are monitored. Anything abnormal like plaque building up in the arteries could be found by this test.
CT Scan:
CT scan is done for the serious illness of the blood from the clot have reached the lungs. The better image through CT scan will help in diagnosing pulmonary embolism.
Laboratory studies:
The laboratory studies are focused on the factor related to hypercoagulability conditions of measurement and evaluation of the following:
Complete blood cell counts, prothrombin time, activated a partial thromboplastin time and serum chemistry values
Protein C and APC resistance and an abnormal case Factor V Leiden test
Protein S level
Antithrombin level
Antiphospholipid antibodies panel or lupus anticoagulant, anticardiolipin anti-beta2-glycoprotein I
Homocysteine level
Histologic findings:
Histologic findings are done to differentiate superficial thrombophlebitis from polyarteritis nodosa in biopsy specimens. Identifying the pattern of muscular which are bundled in veins and non-bundled wreath in the artery is done. Also, attention to their elastic pattern surrounding bundles in veins can help in distinguishing the two ailments.
THROMBOPHLEBITIS TREATMENT:
Treatment to Thrombophlebitis depends on the location and its severity. Clots which were formed due to immobility for a period of time will go away on their own in a week or two. This is mainly of the superficial type and the doctor may recommend taking care of the condition at home. He may prescribe one among the following simple treatments.
Simple treatments for superficial thrombophlebitis:
Usage of graduated support stockings of class I or II while on flight travel or even at home if it is extremely important. They help in blood circulation and also control swelling.
Apply heat for 5-20 minutes twice or thrice a day
Keep the affected leg elevated as much time as possible
Can take anti-inflammatory medications like Ibuprofen
Serious treatments for advanced or deep vein thrombosis:
Not to allow superficial thrombophlebitis to become DVT is very crucial. When the blood clot is near the joint of veins and embedded in them it requires some serious and emergent treatments or may lead to life-threatening PE or Pulmonary Embolism. It could be treated from blood thinner to vein removal.
Blood thinners like Heparin or Fondaparinum (Arixtra) through an IV in the hospital and in the home through shots to control the clot from growing bigger in size
In some cases, antibiotics are prescribed to kill infections which cause poor blood circulation
To stop the clots to reappear an oral drug like Coumadin can be taken for several months
A new breed of blood thinners like Xa inhibitors and direct thrombin inhibitors are now available. They include Apixaban (Eliquis), Dabigatran (Pradaxa), Edoxaban (Savaysa) and Rivaroxaban (Xarelto). But doctors mostly do not prescribe these new medicines because of their high cost and due to the cause of uncontrollable bleeding.
Treatments to control SVT to become DVT:
Superficial thrombophlebitis has a risk of transforming to deep vein thrombosis. This could be highly dangerous and complicated for anyone. Hence the following treatments will be effective in controlling and curing superficial thrombophlebitis and not to make it serious.
Adequate anticoagulation is imperative to prevent long term complications of DVT including PE
Topical treatments are inadequate and low molecular weight heparin (LMWH) or Fondaparinux for 45 days or more is recommended by the American College of Chest Physicians.
LMWH has both anti-inflammatory and anticoagulant properties to decrease perivascular inflammation and limits neutrophil extravasation. They are more effective than the prophylactic doses to prevent thromboembolic combinations.
Studies have proven that the combination of LMWH and nonsteroidal anti-inflammatory drugs (NSAIDs) decreases nearly 70 % incidence of thrombophlebitis spread.
In another study, LMWH was found to be even superior to NSAIDs in preventing extension of DVT.
Relapsing of Superficial venous thrombophlebitis may be treated with subcutaneously placed Fondaparinux or oral Rivaroxaban.
Long-term monitoring with follow up of patients with SVT at weekly intervals is essential until complete resolution occurs to ensure against its progression to DVT. This is more important for patients who take anticoagulant therapy.
Treatments to control DVT to cause PE:
Anticoagulation is essential only in cases of extensive thrombophlebitis or its propagation into the deep venous system. For long-term outpatient treatment oral anticoagulants are prescribed by doctors. They interfere with the vitamin K metabolism and decreases plasma concentrations of the active forms of Factors VII, IX, and X along with proteins C and S. The following anticoagulant medications will help control DVT to cause serious complications.
Enoxaparin (Lovenox):
Enoxaparin is a main anticoagulant to prevent DVT to lead to PE in patients undergoing surgery. It increases the inhibition of factor Xa antithrombin III activity.
Dalteparin (Fragmin) & Tinzaparin (Innohep):
These are the other anticoagulant medicines like Enoxaparin but with a lesser time duration of treatment within 7-14 days.
Warfarin (Coumadin):
This is a long-term anticoagulation medication. It has a half-life of 36-42 hours.
Surgical treatment:
In certain cases of Superficial Thrombophlebitis, the affected vein becomes permanently unsightly with unbearable pain. In other cases, it occurs in the same vein for more than once. In the case of DVT if the veins are affected badly to send the blood back to the lungs surgery is needed to remove the vein.
Incision:
Under idle conditions and circumstances, incision and drainage of the clot are attempted to alleviate pain.
Vein Stripping:
The affected vein for more than once and with constant pain can be surgically removed. This process is known as vein stripping and it will not affect blood circulation. The veins deeper in the leg can support the increased amount of blood flow.
Ligation of veins:
In some cases instead of removing the vein ligation of it is done to control the blood flow.
IVC Filter:
If there is a risk of tissue damage or if the clot comes back to haunt the patient IVC or the inferior vena cava filter is recommended. This could be done once the inflammation improves. Vena cava is the main vein in the abdomen and IVC Filter prevents breaking loose of clots and traveling to lungs.
Patient education:
Treatments should also include the patient education about the risk factors of thrombophlebitis. They should be advised about the importance of anticoagulation therapy and its risks when not taken them. The life-threatening PE or pulmonary embolism should be made understood clearly to avoid it.
PREVENTION OF THROMBOPHLEBITIS:
Prevention is always better than the suffering of the pain of the illness but also due to the financial stress of the hospital bills. Sitting continuously in the same place for hours together or in a flight or car drive increases the chance of thrombophlebitis. Some of the preventive measures include:
If in a hospital bed due to certain reasons, make it sure that the IV lines are changed periodically.
Always make it a precautionary measure of taking a walk once in a while for any desk job.
Moving the legs frequently, flexing the ankles, and also carefully pressing the feet against the footrest for a minimum of 10 times for each hour.
Try to wear loose clothing
Drink plenty of non-alcoholic fluids to prevent dehydration
In this modern world, the technology has made human physical work to the minimum. This is the reason for many illnesses nowadays. Hence to be more agile with physical exercises and good food habits could avoid trouble. According to the nature of work and life, certain precautions and preventions will give a happy life without the sufferings of hospital pain and bills.
