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Thrombophlebitis


Inflammation of the walls of the veins with the formation of a blood clot in them. Phlebitis is distinguished, in which the walls of the veins are inflamed, but there is no thrombosis. A complex of reasons lies in the development of the disease: infection, slowing down the blood flow through the veins, lowering the reactivity of the body, changing the composition of the blood, increasing its coagulability and breaking the integrity of the vessel walls.
There are acute, subacute and chronic thrombophlebitis. By localization, thrombophlebitis of deep and superficial veins is isolated, and by the nature of the process - purulent and non-purulent.
Symptoms and course:
In acute deep vein thrombophlebitis, severe pain in the limb is noted in the first days, the temperature rises to 39.5-40 ± C, significant swelling of the entire limb is observed, the skin on it becomes tense, shiny, pale, and sometimes cyanotic.
A tense limb is usually colder than a healthy one. In cases of the transition of acute thrombophlebitis to purulent, the development of multiple abscesses along the thrombosed vein is observed, which can lead to extremity phlegmon. Very often, acute thrombophlebitis can be cured without going into the chronic stage. The duration of acute thrombophlebitis is from 10 days to 3 months. and more.
Acute thrombophlebitis of superficial veins begins with mild pain along the superficial venous trunks, fever up to 37.5 ± C, rarely up to 38 ± C, and subsequently the temperature becomes subfebrile and normal. Slight swelling of the affected limb is noted. The skin along the veins is hyperemic in the form of strips, then seals of various sizes appear, depending on the diameter of the affected vein, which can be determined with careful palpation. More often affects the large saphenous and, less commonly, the small saphenous vein of the lower extremities. The duration of the disease is from 10 to 30 days.
Chronic thrombophlebitis of deep and superficial veins proceeds for a long time - from several months to 1 year or more.
With migrating thrombophlebitis, the superficial veins of the upper and lower extremities are mainly affected. Painful nodules suddenly appear along the veins, the skin above them swells and turns red. Such nodules occur along the surface veins in different parts of one or the other limb. The general condition of the patient changes little. The temperature is often subfebrile. Migrating thrombophlebitis often recurs and lasts for years. This disease is more common in men. It is characterized by simultaneous damage to arteries and belongs to the group of obliterating thrombangitis.
Treatment:
It can be conservative and surgical. In acute thrombophlebitis (especially deep veins), strict bed rest is recommended, which prevents the spread of microflora and the occurrence of emboli. The elevated position of the limb on the tire helps to improve venous outflow and reduce swelling and pain. Drinking is recommended (up to 2-3 liters per day), if there are no contraindications from the cardiovascular system.
In acute and subacute superficial thrombophlebitis, patients are allowed to turn, sit down, release the limb from the tire for 10-20 minutes. and keep it horizontal. To improve collateral circulation in subacute and chronic thrombophlebitis, warming compresses are recommended. In acute thrombophlebitis, especially in the early days of the disease, thermal procedures, fat dressings due to increased pain should not be used. To reduce pain and improve collateral circulation, lumbar novocaine blockade according to Vishnevsky is used: 80 ml of a 0.25-0.5% novocaine solution is injected into the perinephric tissue of the affected side, repeating injections after 5-6 days (23 times). The use of cold in these cases is permissible if the patient has a pulse on the arteries of the foot of the affected limb. With weakening or absence of pulsation, the cold increases the spasm of the arteries.
Physiotherapeutic methods (ultraviolet irradiation, sollux, infrared rays, etc.) are used in the chronic stage of superficial thrombophlebitis, during the period of thrombus organization. Spa treatment (Pyatigorsk, Sochi-Matsesta) can be allowed strictly individually only for long-term chronic superficial thrombophlebitis without exacerbations and trophic disorders.
For the treatment of thrombophlebitis in all stages, anticoagulants are used in combination with the above methods. Anticoagulants reduce blood coagulation. Hirudinotherapy (leeches) should be used only for acute thrombophlebitis, if the patient has contraindications for anticoagulants. Hirudin, getting from the glands of leeches into the blood, lowers its viscosity and coagulation. Along with this, spasm of arterial vessels disappears. Leeches can be put at the same time 5-10 pieces per limb along the affected vessel, after 5-6 days, repeat the procedure. The skin on the extremities should be shaved and washed with warm water without soap. To quickly suck leeches, the skin is smeared with a glucose solution or sweet water. The force of a leech should not be removed, since it, having pumped 10-20 ml of blood, disappears by itself. It is not recommended to use leeches with anemia, decreased blood coagulation, in the first months of pregnancy and during treatment with mercury preparations.
Dicumarin, neodicumarin, phenyline, sipkumar, etc. reduce the content of prothrombip in the blood and thereby prevent the formation of new blood clots in the vessels, you need to use these drugs under the control of the content of prothrombin in the blood, the norm of which ranges from 87 to 100%, and with thrombophlebitis reaches 117- 127% A decrease in prothrombin to 25-30% should be considered limiting, since further may lead to bleeding from the nose, gums, uterus, hematuria, etc.
A rapid decrease in prothrombin in the blood under the influence of anticoagulants is associated with the age and individual sensitivity of the patient to these drugs. Patients older than 60 are most sensitive to them. With the appearance of microhematuria, the giving of the drug is temporarily stopped. With the appearance of other bleeding, the drug is canceled and blood clotting agents are prescribed (vitamin K, 10% calcium chloride solution inside, transfusion of hemostatic doses of blood and serum).
Anticoagulants are contraindicated in the presence of fresh wounds, ulcers, open forms of pulmonary tuberculosis, diseases of the kidneys, liver, hemorrhagic diathesis, etc. At high temperature or suspected purulent thrombophlebitis, antibiotics are used. As a means of directly affecting blood clots, fibrinolytic drugs are used, which in the early stages of the process lead to the lysis of blood clots. Fibrinolytic drugs include fibrinolysin, streptokinase, urokinase, trypsin, chymotrypsin.
Surgical methods: produce venous ligation, dissection, venectomy and excision of thrombosed nodes of superficial veins.
Prevention:
It is determined by the timely treatment of diseases that are complicated by the development of thrombophlebitis. Patients with varicose veins, trophic ulcers, etc. must undergo surgical treatment in a timely manner. An increase in the level of prothrombin in the blood necessitates the appointment of anticoagulant drugs, which is especially necessary for patients with limited active movements.