Q2.6

Question of the Week

Should the treatment of upper extremity DVT differ from lower extremity DVT?

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10 Responses

  1. Yes. For most upper extremity DVTs we should remove the catheter.

  2. No. The treatment of anticoagulation, thrombolysis or thrombectomy is still necessary to prevent incapacitating, painful and possiblly fatal complications. according to a 2002 article in Circulation by H. Joffe – up to one-third will propegate to a PE…not good odds. Treat them.

  3. no

  4. each pt is different and has to be evaluated and treated based on the following: from uptodate

    For patients diagnosed with catheter-induced UEDVT who have adequate venous access, the inciting catheter should be removed since the thrombosis was provoked by the catheter. For uncomplicated cases, three months of anticoagulation therapy should be sufficient, but the duration depends upon the clinical setting. (See ‘Treatment’ above.)
    For patients diagnosed with catheter-induced UEDVT who do not have adequate venous access, the central catheter should be maintained provided it is still needed, and is functional. Occluded catheters can be treated with urokinase or tissue plasminogen activator in an attempt to salvage the line. (See ‘Catheter’ above.)
    For patients diagnosed with catheter-induced UEDVT, we do not institute deep vein thrombolysis as first line treatment. There is insufficient evidence that any better outcomes are achieved compared to treatment with anticoagulation. (See ‘Deep vein fibrinolysis’ above.)

  5. 1. Yes, it should! (that was a simple question)

  6. yes

  7. No, the treatment of DVTs in the upper and lower extremities is the same. Both should be treated with anticoagulation therapy (although if there is an indwelling catheter in the upper extremity, it should be removed prior to initiating treatment).

  8. yes

  9. Similar treatment with anticoagulation plus immobilization and elevation of the involved extremity, thrombolysis in severe cases, removal of central venous catheter and correction of existing anatomical anomalies to prevent further DVT

    Ferri: Practical Guide to the Care of the Medical Patient, 7th ed.

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