The correct answer is:

Nonsteroidal anti-inflammatory drugs

Educational Objective:

Describe the treatment appropriate for superficial phlebitis.

Key Point:

After deep venous thrombosis is ruled out, superficial phlebitis is treated with nonsteroidal anti-inflammatory drugs, compression, and elevation.

Explanation:

The most appropriate treatment for this patient is a course of nonsteroidal anti-inflammatory drugs. Supportive measures consist of extremity elevation, warm or cool compresses, compression stockings, and pain management.

Patients who present with lower extremity superficial phlebitis affecting the great or lesser saphenous veins should have Doppler ultrasonography to rule out the presence of coexistent deep venous thrombosis (DVT).

Patients with superficial thrombophlebitis who are at high risk for DVT (e.g., the superficial thrombus is in proximity to the saphenofemoral junction, thrombophilia) should be treated with 4 weeks of anticoagulation. This can be done with low-molecular-weight heparin, unfractionated heparin, or warfarin.

There is no role for corticosteroids in the treatment of patients with any form of phlebitis.

If the thrombus extends into the deep venous system, then the patient should be treated according to standard protocols for DVT.

Pearl:

Superficial vein thrombosis (SVT) involves the great saphenous vein in up to 60%–80% of cases.

Figures:

References:

Scovell S. Phlebitis and thrombosis of the superficial lower extremity veins. UpToDate. Updated Feb 18 2021.