Inpatient Management of Thrombophlebitis: A Collaborative Approach Between Internal Medicine and Surgery with Emphasis on Pharmacologic Therapy

Thrombophlebitis, encompassing both superficial thrombophlebitis (STP) and deep vein thrombosis (DVT), is a significant vascular disorder encountered in inpatient settings, often requiring multidisciplinary management.The clinical presentation varies based on location and severity, ranging from localized tenderness in STP to limb swelling and systemic symptoms in DVT.Duplex ultrasonography remains the gold standard for diagnosis, with laboratory tests aiding in complex or septic cases.Hospitalization is warranted in patients with extensive STP, proximity to deep venous systems, or associated infection.Pharmacological treatment includes anticoagulants such as low-molecular-weight heparin, fondaparinux, and direct oral anticoagulants, which effectively prevent thrombus propagation and recurrence.NSAIDs are used for pain control in superficial disease, though caution is advised when concurrent anticoagulation is needed.Antibiotic therapy is reserved for septic thrombophlebitis or catheter-associated infections, targeting common pathogens like Staphylococcus aureus.The internal medicine department coordinates initial assessment, imaging, and pharmacologic therapy, while surgical consultation is essential in refractory or complex cases, including septic thrombophlebitis near the saphenofemoral junction.Surgical interventions such as venous ligation, thrombectomy, or resection are considered when medical therapy fails.A multidisciplinary approach involving internal medicine, surgery, infectious disease, and hematology ensures individualized care, reduces complications, and supports outpatient transition.Structured patient education and follow-up play a critical role in improving long-term outcomes and preventing recurrence.