Management of thrombophlebitis with phenylbutazone

Abstract

I T IS my purpose to present a treatment for thrombophlebitis which aborts the clinical syndrome, cuts down on the need for nursing care and hospitalization, and has a potential for lessening the long term complications of venous thrombosis. These objectives are attained through the use of phenylhutazone,t a nonhormonal drug with anti-inflammatory activity of such high order that it rapidly and effectively resolves inflammation in and about the peripheral veins. My experience with 785 patients treated in this way in the five-)-ear period from 1953 to 1958 follows. .4t first, only patients with superficial phlebitis were selected, a purely arbitrary move but, as events proved, a fortunate enc. Rigid criteria dictated the choice of patient: (1) visible and palpable segments of thrombosed vein had to IX present so that not only could the diagnosis hear scrutin>hut also the effects of treatment he readil). seen and as readily assayed: (2) the phlebitis had to be refractory to traditional treatment. The basic features of such treatment consisted of bedrest with elevation and . . apphcatlon of warm soaks to the affected limb, and the addition of combinations of antibiotic and anticoagulant drugs. In srveral instances ligation of the saphenous and:‘or superficial femoral veins had been performed to little avail. Incidentall>-, an ideal control period was thus pro\.ided for each patient. A predictable clinical pattern soon hecame apparent. The redness, pain and induration so characteristic of acute inflammation in the saphcnous veins and their tributaries, and the palpable and visible areas of superficial vein thromt)osis began to subsidr in the first twelve hours. Ambulation was possible with little or no discomfort in most instances by the end of the same day and was encouraged. Redrest and nursing care were kept to a minimum, and hospitalization was unnecessary except on rare occasions. Onlv once in the past three years was there a medical reason for the latter. The degree of improvement was so impressive that soon patients were included in whom the superficial phlebitis was a troublesome complication of a more important underlying condition.’ These were patients with heart disease, women pregnant and close to term or persons kvith surgical conditions requiring correction. It was then but a short step to give this drug to all patients and to initiate it at the start of signs and symptoms. Table I shows the results ot treatment of the selFera types of phlebitis.