Venous Thrombophlebitis To Treat or Not To 浅静脉血栓性静脉炎的治疗或者不课件.ppt

Superficial Venous Thrombophlebitis: To Treat or Not To Treat - Evidence Behind the 2008 ACCP Recommendations Nathan Wanner, M.D. Clinical Instructor Thrombosis Service Associate Physician Definitions Superficial phlebitis or superficial thrombophlebitis – inflammation of superficial vein ± thrombosis Infusion thrombophlebitis – catheter or blood draw Varicose vein thrombosis – thrombosis involving dilated, tortuous vein usually in SQ tissue of leg Superficial vein thrombosis (SVT) Suppurative (septic) thrombophlebitis Misnomer – superficial femoral vein Eponyms Mondor’s disease – thrombophlebitis involving the breast or the dorsal penile vein Trousseau’s syndrome – migratory thrombophlebitis associated with malignancy, particularly adenocarcinoma of the pancreas Anatomy – Upper Extremity Anatomy – Lower Extremity Deep Veins Anatomy – LE Superficial Veins Clinical Features Clinical manifestations Erythema Pain/tenderness Edema Palpable cord Diagnosis Clinical Venous duplex Beyond “Superficial Thrombophlebitis” Infusion thrombophlebitis Varicose vein (VV) thrombosis Superficial vein thrombosis Above the knee Below the knee Infusion Thrombophlebitis Primarily an inflammatory process (vs. thrombotic) Incidence up to 20-25% with inpatients with PIV Causes Physical trauma Chemical irritation Thrombosis Infection Diagnosis Clinical Venous duplex Develops quickly and spontaneously resolves in days to weeks Infusion Thrombophlebitis - Treatment Heparin gel vs. placebo – 126 inpatients Resolution at 7 days in 44% with heparin vs. 26% with placebo Topical diclofenac vs. systemic diclofenac vs. placebo Positive response 60% in both treatment groups vs. 20% with placebo at 48 hours Heparinoid cream vs. piroxicam gel vs. placebo – 68 pts with infusion-related or spontaneous thrombophlebitis No difference in symptoms at 14 days Topical essaven gel vs. placebo – 23 pts Significant improvement in symptoms with gel No controlled trials evaluating systemic anticoagulation Infusi