Treatment of Superficial Thrombophlebitis With Phenylbutazone (Butazolidin)

Abstract

IN THE medical management of thrombophlebitis, reliance is placed almost completely on bed rest with elevation of the extremity, hot or cold applications, and anticoagulant therapy. Analgesics are frequently used to control pain and antibiotics to combat the chills and fever which sometimes dominate the clinical picture. The latter are of doubtful value, except in the rare case of purulent or septic phlebitis due to bacterial organisms.These measures, when aided by the factor of time, will cause resolution of the thrombophlebitis in most instances in from one to four weeks.There remains, however, a small but important group in whom, despite such therapy, the inflammation in the veins and adjacent tissues may remain active, resulting in considerable disability and economic loss. An agent capable of producing rapid and sustained improvement or subsidence of the phlebitis in these refractory cases would be valuable.Phenylbutazone (Butazolidin) has been found to bring about prompt and frequently dramatic resolution of acute inflammatory conditions, including rheumatoid arthritis, gout, and peritendinitis.* It has relieved psoriatic dermatitis accompanying arthritis 3 and has recently been reported to have been effective in the treatment of erythema nodosum.4 Because of its anti-inflammatory action in these nonspecific and unrelated conditions, phenylbutazone was tried on patients with thrombo¬ phlebitis. METHODOur criteria for the selection of cases were (1) the presence of an active phlebitis, which had persisted in most instances in spite of treatment, and (2) such activity to be present pri¬ marily in the superficial veins, to obviate any difficulty in establishing the diagnosis or in study¬ ing the effect of treatment.Of the 33 patients studied, seven were from hospital wards and outpatient clinics ; the other 26 were seen in private practice at the office. With the exception of two patients, all had been on bed rest for periods of from two to six weeks, receiving the measures outlined in Table 2. These two (Cases 5 and 13) were treated after onset of phlebitis, for reasons outlined in the appended case reports.

Inhibition of Experimental Venous Thrombosis

“…We have attempted to modify the reaction in and about the vein by means of Butazolidin3 (phenylbutazone), a drug which had displayed anti-inflammatory action of a high order under diverse clinical conditions (1)(2)(3)(4) and, more particularly, in the treatment of superficial thrombophlebitis (5).…”