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Phlebitis Causes, Symptoms and Treatment

The phlebitis is a cardiovascular disorder that corresponds to the formation of a blood clot in a vein. This clot completely or partially blocks the blood circulation in the vein, like a plug.
Depending on the type of vein affected (deep or superficial), phlebitis is more or less serious. Thus, if the clot forms in a deep vein , large size, treatment must be provided urgently .

In the vast majority of cases, phlebitis is formed in a vein of the legs, but it can appear in any vein (arm, abdomen …).

Phlebitis often occurs after a long period of immobilization, for example, after surgery or because of a cast.

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Note that in the medical community, phlebitis is referred to as thrombophlebitis or venous thrombosis ( phlebos means “vein” and thrombus , “clot”). We therefore speak of deep vein thrombosis or superficial vein thrombosis.

Types of Phlebitis

It is important to distinguish between the two types of phlebitis, with very different consequences and treatments.

  • Superficial phlebitis . In this case, the blood clot forms in a surface vein . This is the most common form, which mostly affects people with varicose veins . It is accompanied by an inflammation of the vein and causes pain and discomfort. Although superficial phlebitis may seem innocuous, it should be considered as a warning signal. Indeed, it is usually a sign of advanced venous insufficiency that can lead to deep phlebitis.
  • Deep phlebitis . When the blood clot forms in a deep vein with a high blood flow, the situation is more dangerous since the clot may come off the vein wall. Carried by the blood flow, it can then cross the heart and then obstruct the pulmonary artery or one of its branches. This leads to a pulmonary embolism , a potentially fatal accident. Most often, this type of clot forms in a vein of the calf.

Prevalence

Deep phlebitis affects more than 1 in 1,000 people each year. In Quebec, there are approximately 4,700 cases per year. Fortunately, effective prevention strategies can reduce the frequency of pulmonary embolism and deaths associated with deep phlebitis.

Causes of Phlebitis

Although we do not always know the causes, phlebitis is generally related to 3 major factors:

  • The blood that stagnates in a vein, instead of circulating fluidly (we speak of venous stasis). This situation is typical of venous insufficiency and varicose veins , but it can also be due to prolonged immobilization (plaster, bed rest …);
  • lesion in the wall of a vein, caused by the wearing of a catheter , a wound, etc. ;
  • Blood that coagulates more easily (some cancers and some genetic abnormalities, for example, make the blood more viscous). Trauma, surgery, pregnancy can also reduce the fluidity of blood and increase the risk of clot.

In about half of people who have it, phlebitis occurs spontaneously and cannot be explained. Nevertheless, risk factors have been discovered. See People at Risk and Risk Factors.

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Complications

The main risk of deep phlebitis is the occurrence of pulmonary embolism . This accident occurs when the blood clot that has formed in the leg comes off, “travels” to the lungs and obstructs the pulmonary artery or one of its branches. Thus, more than 70% of pulmonary embolism cases are caused by a blood clot initially formed in a vein of the legs.

In addition, when a deep vein is affected, symptoms of venous insufficiency may occur, such as persistent leg swelling ( edema ), varicose veins and leg ulcers . These symptoms result from damage to the valves by the blood clot. Valves are a kind of “valve” that prevents blood from flowing back into the veins and facilitates circulation to the heart. In medical terms, it is a post-phlebitic syndrome . Because phlebitis often affects only one leg, this syndrome is usually unilateral.

As for superficial phlebitis , it has long been considered as not serious. However, several recent studies have shown that superficial phlebitis often “hides” deep phlebitis that may go unnoticed. In 2010, a French study conducted on nearly 900 patients even showed that 25% of superficial venous thromboses were accompanied by deep phlebitis or pulmonary embolism.

Symptoms of phlebitis (blood clot)

Superficial phlebitis

  • The affected vein is red, hot and forms a hard “cord”. This inflammation can spread to the surrounding skin area. The vein is often visible since it is a surface vein;
  • The area of ​​the affected vein is painful or sensitive to touch. The affected vein may remain painful for several months;
  • Sometimes the affected area swells slightly (local edema).

Deep phlebitis

The symptoms depend on the importance of the inflammatory reaction and the size of the clot. There are sometimes no symptoms, which makes the disease all the more dangerous. However, in 1 in 2 people, we can observe the following signs in the affected leg:

  • A dull pain in the calf or thigh. It can also be numbness or cramps;
  • A feeling of warmth
  • Swelling (edema) of the calf or ankle, or even the entire leg. The skin is shiny and hard, white or bluish;
  • A pain when raising the tip of the foot upwards, towards oneself (Sign of Homans);
  • A slight fever (38 ° C).
In the presence of these symptoms, consult a doctor as soon as possible since the risk of pulmonary embolism is high.

Pulmonary embolism can be recognized by sudden shortness of breath, chest pain and sometimes coughing up of blood. A loss of consciousness can occur. Unfortunately, pulmonary embolism occurs without any sign of phlebitis.

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People at risk for Phlebitis

  • People who suffer from venous insufficiency or who have varicose veins;
  • People who have already suffered from phlebitis, or whose family member has already suffered from phlebitis or pulmonary embolism. After a first phlebitis, the risk of recurrence is multiplied by 2.5;
  • People who undergo major surgery and must, therefore, remain bedridden for several days (for example, surgery on the hip) and those who must wear a cast;
  • People hospitalized because of a heart attack, heart failure or respiratory failure;
  • People who have a pacemaker and those who have been catheterized into a vein to treat another disease. The risk is then greater than phlebitis appears in one arm;
  • People with cancer (some types of cancer cause blood clotting, especially those of the chest, abdomen and pelvis). Thus, it is estimated that cancer increases the risk of phlebitis by 4 to 6. In addition, some drugs used in chemotherapy increase the risk of clot;
  • People with paralysis of the legs or arms;
  • People with blood clotting disease (thrombophilia) or inflammatory disease (ulcerative colitis, lupus, Behçet’s disease …);
  • Pregnant women, especially at the end of pregnancy and immediately after giving birth, are at risk of phlebitis multiplied by 5 to 10;
  • People suffering from obesity;
  • The risk of phlebitis increases very strongly with age. It is multiplied by 30, from 30 years to 80 years.

Risk factors

  • Stay in a  stationary position  for several hours: working while standing for long periods, driving long distances by car or plane, etc. Journeys of more than 12 hours increase the risk. In the aircraft, the slightly lower oxygen pressure and the dry air seem to increase the risk further. We even speak of ”  economic class syndrome  “. The risk remains minimal: 1 in 1 million 2 .
  • In women, taking hormone  replacement therapy at menopause or  oral contraceptives  is a risk factor because these drugs increase blood clotting. Oral contraception increases the risk of phlebitis by 2 to 6
  • Smoking.

Prevention of phlebitis (blood clot)

Why prevent?
  • To avoid the multiple discomforts that accompanies phlebitis, as well as its complications, potentially fatal.
  • The measures that prevent deep phlebitis, especially in case of surgery or prolonged hospitalization, are effective in 90% of cases, when well chosen in collaboration with a doctor 2 .
  • To prevent recurrence, if it is not properly prevented, deep phlebitis reappears within 5 years after a first attack, in about 1 in 3.

 

Measures to prevent phlebitis and its recurrence
  • In cases of venous insufficiency or varicose veins, measures can be taken to prevent the situation from worsening and leading to a risk of phlebitis.
  • Avoid sitting still for several hours. For air travel, see the tips below. In general, it is important to exercise regularly, and to walk at least 30 minutes a day to stay healthy and maintain good blood circulation.
  • Well hydrate yourself . Nutritionists recommend drinking an average of 1.5 to 2 liters of water or drink (juice, broths, tea, coffee, etc.) each day unless directed by a doctor. This recommendation serves as a benchmark but does not rely on accurate scientific data.
  • Do not wear clothing that impedes movement, such as tight ankle or knee socks or tight waist pants.
  • To prevent phlebitis, doctors encourage bedridden patients , those who have recently undergone surgery, and women who have just given birth to get up and walk as soon as possible. The approval of the doctor is necessary.
  • In persons at low risk for severe phlebitis, the use of compression stockings during risky situations is sufficient as a preventive measure. Ideally, new stockings should be obtained every 3 months since they lose their elasticity over time.
  • In people at high risk of deep phlebitis, the doctor sometimes prescribes anticoagulant medication (heparin or warfarin). This medicine can be given as a preventive measure at the time of hospitalization or surgery, for example.

 

During a long flight by plane (or any other long journey)
Here are some tips that can help improve comfort and prevent phlebitis during flights lasting 6 hours or more.

  • Occasionally stand up to stretch and walk a little. In a seated position, practice about fifteen movements of flexion and extension of the ankles every hour. This exercise will help stimulate the return of blood to the heart;
  • Avoid keeping your legs crossed too long and make sure the edge of the seat does not compress the blood vessels of the thighs;
  • Wear loose clothing that does not over-tighten your legs and waist so you do not interfere with blood circulation;
  • Be sure to hydrate well by drinking water before, during and immediately after the flight;
  • Avoid drinking alcohol, which dehydrates;
  • During the flight, avoid taking sleeping pills, which slow down movements and contribute to stagnation of the blood;
  • Avoid sleeping for extended periods (the risk of phlebitis is higher after 2 hours of sleep). To sleep, raise the legs if space permits;
  • People at risk for phlebitis should discuss with their doctor before they leave the possibility of wearing compression stockings or taking anticoagulant medications.

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Diagnostic of phlebitis (blood clot)

Although a simple physical examination can be used to diagnose superficial phlebitis, venous ultrasound or contrast radiography should usually be performed to detect the presence of blood clots in the deep veins. In practice, the most used examination is Doppler ultrasound , which allows the visualization of blood flow in the veins. Pain, edema, discolouration of the skin and warmth in the legs are signs that may prompt the doctor to perform an ultrasound or X-ray.
blood test, intended to measure the level of D-dimer, a substance released by the clot, can sometimes be done to confirm the absence of phlebitis if the doctor has a doubt.

Treatments of phlebitis (blood clot)

In cases of superficial phlebitis , local treatment, which can be done at home, is sufficient. Rest is advised, with elevation of the leg and application of warm compresses on the affected area. The compresses can be applied for 15 to 30 minutes, 2 to 3 times a day. Wearing a venous contention is often advised for a few days or weeks. These are bandages or elastic stockings that slightly compress the calf or leg and thus help the blood to go back to the heart.

The patient may also take anti-inflammatory drugs: the pain subsides in a few days, but the inflammation can persist for 2 to 3 weeks. Although there is no formal medical recommendation, a new treatment is sometimes advocated. It consists of taking anticoagulant medications for a few days to 1 month. Anticoagulants (eg, heparin) prevent or delay the formation of clots in the blood, and also contribute to their dissolution.

Patients with varicose veins who have recurrent phlebitis may be surgically removed from the portion of the vein that is affected, a procedure commonly known as stripping .

In case of deep phlebitis , anticoagulant drugs are injected intravenously or subcutaneously in an emergency in order to dissolve the blood clot. The most commonly used anticoagulant is the heparin of low molecular weight, injected daily for 5 to 7 days . A recent drug, fondaparinux (Arixtra), can also be used.

After these initial injections, an oral anticoagulant treatment (warfarin or Coumadin) is put in place, in order to avoid recurrences. This treatment will continue over a period of 3 months to several years, depending on the patient and his risk factors. In general, the treatment lasts 6 to 12 months.

The daily wearing of compression stockings is also recommended at diagnosis and for at least 3 months. This helps to reduce edema and prevent complications (including post-thrombotic syndrome). As a rule, bed rest should be kept as short as possible.

In some cases, especially when the use of anticoagulants is contraindicated, a filter can be placed in the inferior vena cava (located in the abdomen) to prevent the passage of clots to the lungs. . This procedure does not require hospitalization.

Sometimes surgery is required to remove a clot that blocks a vein in the pelvis or abdomen ( thrombectomy ). You can also perform angioplasty to open the vein and set up a stent (a small tube) that will keep the vein open.

Important

  • In case of swelling or sudden pain, avoid massaging the affected area, which may aggravate the situation.
  • The vitamin K , contained mainly in green vegetables and algae, can counter the action of anticoagulants. People on oral anticoagulants should simply avoid suddenly change the amount of green vegetables and algae they consume. For more information, see Vitamin K.

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