Acute Upper-Extremity DVT
Axillary or more proximal veins
Preferred
(or IV or subcut UFH) x ≥ 3 mos
LMWH daily or fondaparinux
OR
Thrombolysis + Anticoagulation
3 months Surgical
1st high bleed risk or 2nd
Duration of Anticoagulation by Cause Extended
Transient Factor Unprovoked –
Unprovoked 1st
low-moderate bleed risk Cancer (LMWH preferred)
or 2nd Unprovoked – Table 3. Risk Factors for Bleeding With and
Contraindications to Use of Thrombolytic Therapy (Both Systemic and Locally Administered)
Major contraindications Structural intracranial disease
Previous intracranial hemorrhage Ischemic stroke within 3 mo
Active bleeding Relative contraindications
Systolic BP > 180 mm Hg Diastolic BP > 110 mm Hg
Recent bleeding (not intracranial) Recent surgery
Recent invasive procedure Traumatic cardiopulmonary resuscitation 13
Pericarditis or pericardial fluid Diabetic retinopathy Pregnancy Age > 75 y
Low body weight (eg, < 60 kg)
Ischemic stroke more that 3 mo previously Female sex Anticoagulated (eg, VKA therapy)
Black race Recent brain or spinal surgery
Recent head trauma with fracture or brain injury
Bleeding diathesis
