Education Blog for Healthcare Professionals

Catheter-Associated DVT of Arm and Neck in Cancer Patients: ISTH Guidance

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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