Thrombophlebitis and thromboembolism: results of a prospective study

Thrombophlebitis leading to pulmonary embolism has been stated to cause as many as 9% of hospital deaths. Its diagnosis, sites of common occurrence, treatment and immediate sequelae have long been controversial subjects. A prospective study of thrombophlebitis was set up to evaluate these problems. One hundred and sixty-six patients diagnosed clinically as having thrombophlebitis or pulnmonary embolus were studied with the ultrasonic flow detector (doppler). To assess the stated accuracy of this instrument, venograms were done when possible. The doppler proved in this series to be 93% accurate as compared to venography which is comparable to other series. Pulmonary scans and angiograms were obtained from patients suspected of having pulmonary emboli. Results were as follows: 1) Of 113 patients suspected of having thrombophlebitis clinically, only 26 (23%) of the cases were confirmed by doppler; 2) Of 53 patients suspected of having pulmonary embolus clinically, only 18 (34%) had confirmation by scan, angiogram or doppler; 3) Of 39 patients in this series who had thrombophlebitis, 11 (23%) were not suspected of having lower extremity venous disease until pulmonary embolus occurred, 4) Calf vein thrombosis without additional proximal occlusion was present in only 10% of cases; and 5) Thirty per cent of doppler or venographically proven cases of thrombophlebitis occurred after orthopedic injuries or operations. It was concluded that physical examination alone was grossly inaccurate in determining the recurrence of lower extremity thrombosis. In fact physical examination alone appeared to select out for treatment large numbers of patients without venous disease while a significant number of patients with thrombophlebitis remained clinically asymptomatic until pulmonary embolism occurred. Most deep venous disease was found in the larger veins above the knee, explaining the paucity of diagnostic symptoms in these individuals. The ultrasonic flow detector was found to be an extremely accurate, simple and rapid bedside test that could be applied daily to the high risk groups. The appearance of thrombosis could then be treated with heparin with excellent prospects of preventing occurrence of pulmonary embolus.