I see people in the office who come in with the abrupt onset of leg pain with a red and tender cord that they can see and feel. They are understandably concerned about whether this is an infection or a blood clot. In most cases, this is a condition called phlebitis, which for most people is not dangerous. The tenderness and redness are due to inflammation, which does respond to treatment.
Understanding Phlebitis
Phlebitis is a medical term that refers to vein inflammation, and it almost always is a result of a clot in the vein, which is called thrombophlebitis. It can be superficial under the skin or affect the deep veins. Most of the time, the inflamed vein also forms a clot inside. This clot is typically not dangerous but this depends on its location under the skin (more worrisome in the upper thigh) and whether the deep veins have a clot in them. A red tender cord under the skin is the primary symptom of superficial phlebitis. When the vein closes off due to a variety of causes, the clot inside triggers an inflammation response. The result is swelling, pain, redness, and tenderness and there is often a visible cord at the site.
Phlebitis is rarely associated with infection, so antibiotics are often unnecessary. If an infection is present there will be red tender swollen skin extending away from the red vein cord. A fever may be present. Your provider will help sort this out and prescribe antibiotics if needed.
Phlebitis can be an indication of an abnormal vein condition under the surface, and very often develops in varicose veins. It can also occur as a result of immobility or pregnancy, both of which are associated with slow blood flow in the leg veins. The abnormal blood flow results in the formation of a blood clot, triggering an inflammation reaction. The inflammation irritates the skin nerves causing discomfort and tenderness. The goal of treatment is to alleviate discomfort and resolve the tender red cord.
Most Common Phlebitis Treatments
Applying an ice pack and taking non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen will help bring inflammation under control. If your symptoms do not respond, you may benefit from a prescription oral steroid such as prednisone or methylprednisolone. Blood thinners are an appropriate recommendation when a blood clot has reached deep veins or the phlebitis is traveling up the thigh each day. This situation is most common in pregnant women. If you are pregnant, check with your OB-GYN before taking any medication.
It's normal to develop phlebitis after other types of vein treatment since vein treatments close veins down. Applying ice packs throughout the day and taking NSAIDs as needed should help to reduce any discomfort and cause the veins to fully seal. It’s especially important to remain active by walking after vein treatment since this reduces the chance of a DVT (deep vein thrombosis).
Potential Risk of Phlebitis
Phlebitis occurs when a varicose vein closes off, and this rarely creates a risk for DVT. Your risk of a DVT blood clot increases if you have large and bulging varicose veins leading into your groin or behind your knee. The easiest way to tell you you’re at increased risk is to look for a red streak pointing to your groin or knee. If you are concerned, make sure you have your provider order a DVT ultrasound.
If you have phlebitis but don’t have varicose veins, you may have a risk of forming DVT in other deep veins. This requires diagnosis with an ultrasound. Should you have a DVT, the most likely recommendation will be monitoring via ultrasounds and starting a blood thinner if it’s right for your situation. Your risk of DVT is only slightly elevated if you have superficial phlebitis. You may need to start an anti-coagulation drug if you have had one or more DVTs in the past - your provider can advise you on this.
Although rare, some people develop phlebitis in both their arms and legs. The medical terms for this are migratory thrombophlebitis or Trousseau’s sign. This can be the first indication of some types of cancer, so it’s essential to bring this to the attention of your regular healthcare provider.
Please feel free to download our eBook to learn more about blood clots. If you are concerned that you may have an underlying vein condition, we invite you to visit our online vein screening options and complete the form to find out.
