Chronic Thromboembolic Pulmonary Hypertension (CTPH)
ÎIn patients with CTPH, the ACCP recommends extended anticoagulation over stopping therapy (1-B).
ÎIn selected patients with CTPH, such as those with central disease under the care of an experienced thromboendarterectomy team, the ACCP suggests pulmonary thromboendarterectomy over no pulmonary thromboendarterectomy (2-C).
Superficial Vein Thrombosis (SVT)
ÎIn patients with SVT of the lower limb of at least 5 cm in length, the ACCP suggests the use of a prophylactic dose of fondaparinux or LMWH for 45 days over no anticoagulation (2-B).
Remark: Patients who place a high value on avoiding the inconvenience or cost of anticoagulation and a low value on avoiding infrequent symptomatic VTE are likely to decline anticoagulation.
ÎIn patients with SVT who are treated with anticoagulation, the ACCP suggests fondaparinux 2.5 mg daily over a prophylactic dose of LMWH (2-C).
Acute Upper-Extremity DVT (UEDVT)
ÎIn patients with UEDVT that involves the axillary or more proximal veins, the ACCP recommends acute treatment with parenteral anticoagulation (LMWH, fondaparinux, IV UFH, or subcut UFH) over no such acute treatment (1-B).
ÎIn patients with acute UEDVT that involves the axillary or more proximal veins, the ACCP suggests LMWH or fondaparinux over IV UFH (2-C) and over subcut UFH (2-B).
ÎIn patients with acute UEDVT that involves the axillary or more proximal veins, the ACCP suggests anticoagulant therapy alone over thrombolysis (2-C).
ÎIn patients with UEDVT who undergo thrombolysis, the ACCP recommends the same intensity and duration of anticoagulant therapy as in similar patients who do not undergo thrombolysis (1-B).
ÎIn most patients with UEDVT that is associated with a central venous catheter, the ACCP suggests that the catheter not be removed if it is functional and there is an ongoing need for the catheter (2-C).
ÎIn patients with UEDVT that involves the axillary or more proximal veins, the ACCP suggests a minimum duration of anticoagulation of 3 months over a shorter period (2-B).
Remark: This recommendation also applies if the UEDVT was associated with a central venous catheter that was removed shortly after diagnosis.
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