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Superficial venous thrombophlebitis EBM Guidelines. Essentials Thrombophlebitis is a common disease of the superficial veins that most commonly occurs in the lower extremities especially Clexane Bewertungen Thrombophlebitis the great saphenous vein [vena saphena magna] and often is connected with varicose veins.
It can also occur elsewhere, e. As opposed to deep vein thrombosis DVTan inflammatory process of the venous wall is almost always present in addition to thrombosis. The prognosis of superficial thrombophlebitis is usually good. A more extensive superficial venous thrombosis may spread to the deep veins.
Ultrasonography is helpful in the differential diagnostics and it Clexane Bewertungen Thrombophlebitis recommended to exclude deep vein thrombosis. D dimer is not helpful in the differentiation between superficial and deep venous thrombosis. Muscular vein thrombosis and superficial thrombophlebitis Clexane Bewertungen Thrombophlebitis often mixed up. Muscular vein thrombosis is not a superficial thrombophlebitis but a sub-category of deep vein thrombosis, in which the thrombosis is located geschwollenen Thrombophlebitis Fuß the muscular veins of Clexane Bewertungen Thrombophlebitis calf region plexus soleus or plexus gastrocnemius.
Predisposing factors Clexane Bewertungen Thrombophlebitis factors include damage to the venous intima superficial trauma, drug infusion, intravenous use of illicit drugsdecreased venous flow varices, chronic venous insufficiency, pregnancy, prolonged immobilizationincreased thrombotic tendency malignancy, coagulation disorder, hormonal therapy or a combination of these.
The condition may also appear without any clear predisposing factor. May be associated with vasculitis. Approximately one third of these patients also have superficial venous thrombi. Clinical picture The affected venous area is painful, reddish and swollen.
The vein is hard and tender on palpation. An extensive phlebitis often is associated with fever and a mild increase of CRP concentration.
A superficial venous thrombosis may spread to the deep veins. Deep vein thrombosis is the more likely the closer the superficial thrombophlebitis is either to the saphenofemoral junction in the groin or to the perforant veins in the popliteal area. The clinical picture is often benign and self-limiting. The inflammation and the symptoms take usually 3—4 weeks to resolve, but sometimes the condition may become prolonged. The thrombosed vein may be felt Clexane Bewertungen Thrombophlebitis click to see more. Superficial venous thrombosis may recur, particularly if it was associated with varices.
Diagnosis The diagnosis is based on clinical examination. The determination of the D dimer concentration is not helpful in the differentiation between superficial and deep venous thrombosis. Ultrasonography is indicated at least, if the clinical picture is not obvious differential diagnosis there are concomitant clinical signs that suggest deep venous thrombosis superficial thrombophlebitis is located proximal to the knee, especially if it is close to junction of vena saphena magna, i.
Treatment The aim of treatment is to alleviate local symptoms as well as to prevent thrombosis from spreading into the deep veins Clexane Bewertungen Thrombophlebitis embolization to lungs. Symptoms Clexane Bewertungen Thrombophlebitis be alleviated Clexane Bewertungen Thrombophlebitis compressive stockings, cold compresses and by keeping the leg elevated.
Similar treatment is indicated, if the thrombus is located irrespective of its length at a distance of Clexane Bewertungen Thrombophlebitis than 3 cm from the saphenofemoral junction located in the groin. Some experts recommend that patients with superficial thrombophlebitis that is located close to the saphenofemoral junction should be given similar anticoagulant treatment as in deep vein thrombosis.
According to the SURPRISE trial published init seems that 6-week Clexane Bewertungen Thrombophlebitis with rivaroxaban 10 mg once daily would not be inferior to 6-week therapy with fondaparinux 2. More research is needed, but rivaroxaban therapy may already now be considered for these patients.
It is probably worthwhile, at least for the time being, to treat higher-risk patients e. The practicality of rivaroxaban is its benefit. There is Clexane Bewertungen Thrombophlebitis evidence regarding http://billigzeit.de/als-sophagusvarizen-zu-behandeln.php direct oral anticoagulants.
During pregnancy, LMWH treatment is used and der in Gynäkologie Thrombophlebitis throughout pregnancy and for 6 weeks after the end of pregnancy. If the criteria for anticoagulant therapy described above are not met, the patient may use oral NSAIDs, which alleviate symptoms but do not affect the thrombotic process.
Topically applied anticoagulant cream may alleviate the symptoms of a local venous thrombosis, but there is Clexane Bewertungen Thrombophlebitis evidence that it would prevent the spreading of the thrombosis to the deep veins. Antimicrobial therapy is not needed and it should only be commenced if the see more clearly has another concomitant infection.
Superficial thrombophlebitis associated with an intravenous cannula is usually not treated with Clexane Bewertungen Thrombophlebitis anticoagulants. The patient is recommended to start moving around Clexane Bewertungen Thrombophlebitis soon as the symptoms allow immobility may increase the risk of deep venous thrombosis.
A patient with an extensive or recurring superficial thrombophlebitis should be referred to specialist care. Surgery appears für Schmerzen von Krampfadern to be beneficial in the acute phase of superficial thrombophlebitis.