Superficial thrombophlebitis and deep vein thrombosis
- Superficial thrombophlebitis: a painful dense cord appears along the saphenous vein, the skin over it becomes red and hot. Swelling of the entire leg is unusual. Often against the background of varicose veins
- Deep vein thrombosis: there may be no external changes at all. There is a bursting pain in the calf, swelling of one leg, a feeling of heaviness; the skin is sometimes bluish. This is where the thrombus goes into the pulmonary artery
Опасное заблуждение — считать поверхностный тромбофлебит безобидным. Если тромб распространяется вверх и достигает места впадения подкожной вены в глубокую, риск перехода в глубокую систему и ТЭЛА резко возрастает. Поэтому уровень тромба обязательно определяют по УЗИ.
Why does a blood clot form?
Classically, three conditions are distinguished: slow blood flow, damage to the vessel wall, and increased clotting. In practice it looks like this:
- Varicose veins are the most common cause of superficial thrombophlebitis
- Prolonged immobility: bed rest, casting, long flights and trips
- Operations, especially on joints and in the abdominal cavity, injuries
- Oncological diseases - sometimes thrombosis becomes their first manifestation
- Pregnancy and the postpartum period, taking hormonal contraceptives
- Dehydration, smoking, obesity
- Hereditary clotting disorders (thrombophilia)
- Catheters and intravenous injections are the cause of thrombophlebitis of the veins of the arm
What to do and what not to do
- Обратиться к врачу в тот же день; при одышке и боли в груди — вызвать скорую.
- Не массировать, не растирать и не разминать ногу — это может «сорвать» тромб.
- Не прогревать: ни грелки, ни горячие компрессы, ни баня.
- Не назначать себе мази с гепарином и обезболивающие вместо обследования.
- До осмотра — покой без строгого постельного режима, нога в приподнятом положении.
Examination and treatment
- Duplex scanning of veins is the main method: determines the presence of a blood clot, its extent and mobility of the apex
- D-dimer - auxiliary assay; a negative result with a low probability helps to exclude thrombosis
- For confirmed deep vein thrombosis - anticoagulant therapy, duration determined by cause (usually from 3 months)
- Compression hosiery - reduces swelling and reduces the risk of post-thrombotic syndrome
- For ascending superficial thrombophlebitis with the threat of transition to the deep system - surgery (crossectomy)
- Early activation and walking - bed rest is not recommended, it worsens the outcome
- Search for the cause: in case of unprovoked thrombosis, examination for oncology and thrombophilia
Антикоагулянты нельзя отменять самостоятельно при улучшении: именно на фоне отмены чаще всего возникает повторный тромбоз. Длительность терапии определяет врач.
Prevention
- Movement during long flights and trips: get up every hour, move your feet
- Drink enough, avoid alcohol on the road
- Compression jersey for flights, pregnancy, standing work, after operations
- Early activation after operations and injuries
- Treatment of varicose veins before complications develop
- Quitting smoking, especially when taking hormonal contraceptives
