Saturday, 23 March 2013

Phlebitis requires urgent scanning to prevent DVTs and PEs

At this morning's session at the Indovasc Symposium 2013, Mark Whiteley gave a talk entitled:

Superficial Venous Thrombosis - To Treat or Not?
Mark Whiteley

In the talk, Mark explained how the treatment of "Phlebitis" in the legs has completely changed over the last couple of years.

Until recently, "phlebitis" or superficial venous thrombosis of the leg, was considered to be a benign condition without any risk the patient. As such, doctors and nurses have been used to diagnosing this clinically and then treating with aspirin and graduated pressure stockings-and occasionally those who do not understand the process have used antibiotics.

However recommendations from the American College of Chest Physicians (ACCP) and the British Committee for Standards in Haematology in 2012 have produced new guidelines based upon randomised controlled studies that have been performed over the previous 2 to 3 years.

The key points are:
  • "Phlebitis" of the legs (superficial venous thrombophlebitis) is associated with deep vein thrombosis (DVT) and pulmonary embolism (PE) in a few patients
  • Treatment of superficial venous thrombophlebitis of the legs has shown to reduce the extension of clot, reducing deep vein thrombosis (DVT) and pulmonary embolism (PE)
Therefore it is now incorrect to diagnose "phlebitis" or superficial venous thrombophlebitis of the legs clinically and treat with aspirin, antibiotics and/or graduated pressure stockings as this will mean any underlying deep vein thrombosis (DVT) is missed and potential clot extension is more likely.

Hence the new recommendations are:
  • Anyone thought to have "phlebitis"or superficial venous thrombophlebitis needs to have a venous duplex ultrasound scan as soon as possible
  • If a DVT is identified, full anticoagulation needs to be started
  • If the clot is in the Great Saphenous Vein and close to the SaphenoFemoral Junction, full anticoagulation needs to be started
  • If the clot is less extensive but there are other factors then prophylactic low molecular weight heparin should be given
  • For more minor cases proven on venous duplex ultrasound scanning, non-steroidal anti-inflammatory tablets are sufficient
These guidelines show that "phlebitis" of the legs can no longer be treated as a minor condition as this may lead the patient to potentially dangerous deep vein thrombosis (DVT) or pulmonary embolism (PE).

Every patient with "phlebitis", or suspected to have "phlebitis", needs to have an urgent venous duplex ultrasound scan arranged and appropriate treatment prescribed upon the scan results.

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