Stephan Moll, MD writes… This week (Feb 18th, 2014) a guidance document on the prevention and management of catheter-associated upper extremity (brachial, axillary, subclavian, and brachiocephalic veins) and neck (internal jugular) DVT was published by the International Society for Thrombosis and Haemostasis (ISTH) [ref 1]. The authors acknowledge that optimal long-term management of catheter-associated DVT has not been established. The key recommendations:
A. Prevention
- Prophylactic anticoagulation: Recommend AGAINST the routine administration of pharmacologic prophylaxis to prevent catheter-associated DVT.
- Heparin flushes: Recommend AGAINST their routine use to prevent catheter-associated DVT.
B. Treatment
- If catheter is functional and needed: give LMWH WITHOUT removal of catheter for at least 3-6 months and as long as the catheter is in place.
- If catheter is not needed, give short course of anticoagulation (3-5 days) and then remove catheter. Afterwards give LMWH for 3-6 months.
- Incidentally discovered catheter-associated DVT: ISTH suggests anticoagulation over no anticoagulation. Alternatives strategies: serial ultrasound follow-up.
- In thrombocytopenic patients: decision to anticoagulate needs to be made on an individual basis, weighing risks and benefits.
Reference
Zwicker JI et al. Catheter-associated deep vein thrombosis of the upper extremity in cancer patients: guidance from the SSC of the ISTH. Feb 18th, 2014 (pre-published on the web) – link to abstract here.
Disclosures: I have no relevant financial disclosures.
Last updated: Feb 20th, 2014
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