The Treatment of Thrombophlebitis Without Anti Coagulation : Report of Five Cases

Abstract

Five patients with active thrombophlebitis diagnosed by signs and symptoms, and confirmed by thermograms and venograms, were admitted to Moss Reha bilitation Hospital, Philadelphia, Pennsylvania. They all had relative or abso lute contraindications to anticoagulation (gastrointestinal and genitourinary bleeding, and deep decubitus ulcers). They were not treated by the conventional means of bed rest, warm soaks and elevation of the involved extremity. The treatment consisted of a full rehabilitation program, including range of motion, transfer and ambulation exercises. They were fitted with anti EM stockings, and the extremities were elevated when at rest. The goal in treating thrombophlebitis should be early resolution of the condi tion, and prevention of pulmonary embolism. Bed rest leads to venous stasis, predisposes the patient to extension of the thrombus and increases the incidence of thromboembolism. Therefore, patients were mobilized immediately. Elastic stockings and elevation of the extremity have also been shown to increase venous flow, leading to a decrease in the formation and extension of the throm bus, and to a reduction of the threat of thromboembolism. There was no evidence of thromboembolism in the five cases. Thus, an active program of exercise and ambulation, in addition to anti EM stockings and elevation of the extremity when at rest, is worth considering, even though thrombophlebitis has occurred and anticoagulation is contraindicated. This is especially true in a rehabilitation program where ambulation is a significant goal. Experiences with larger numbers of such patients would help to confirm this impression.