Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2019 Sep;34(8):552-558.
doi: 10.1177/0268355519827155. Epub 2019 Jan 31.

Variability in the management of line-related upper extremity deep vein thrombosis

Rafael Cires-Drouet  1   2 , Jashank Sharma  1 , Tara McDonald  3 , John D Sorkin  3   4 , Brajesh K Lal  1   2
Affiliations
Comparative Study

Variability in the management of line-related upper extremity deep vein thrombosis

Rafael Cires-Drouet et al. Phlebology. 2019 Sep.

Abstract

Objectives:: Central-venous devices are risk-factors for upper extremity deep vein thrombosis. We surveyed physicians to identify practice-patterns and adherence to American College of Chest Physicians guidelines.

Methods:: The 13-question survey obtained physician-demographics and treatment-choices. Respondents were grouped into surgical and medical specialists. Data were reported as ratios and percentages, and compared using Fisher’s exact test.

Results:: We received 143 responses from physicians; 65% treated one-to-two new cases/month. Most physicians (69.2%) used anticoagulation; 36.4% retained the catheter and 32.9% removed it. Medical-specialists retained catheters more often than surgeons (p = 0.027). For recurrences, 84% repeated anticoagulation; 50.3% retained the catheter. A majority anticoagulated upper-extremity deep-vein thrombosis in long-term catheters for three months only (55.1%). Direct oral anticoagulants were used frequently (43.6%). Only 10% believed that existing guidelines were appropriate and only 2.8% followed all guidelines.

Conclusion:: There is great variability in treatment-decisions for upper-extremity deep-vein thrombosis. The existing guidelines are considered inadequate and not followed by most physicians.

Keywords: Deep vein thrombosis; anticoagulation; catheter; intravenous device; upper extremity.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Questionnaire for upper extremity deep vein thrombosis survey.
Figure 2.
Figure 2.
Preferred treatment strategy by specialty Surgery vs. Medicine.
Figure 3.
Figure 3.
Duration of anticoagulation in patients with functional long-term intravenous catheters in the presence of upper extremity deep vein thrombosis (UE-DVT) by specialty Surgery vs. Medicine.
Figure 4.
Figure 4.
Variability in preferred type of anticoagulation for patients with upper extremity deep vein thrombosis per specialty Surgery vs. Medicine. UFH: unfractionated heparin; LMWH: low-molecular weight heparin; DOACS: direct oral anticoagulants.
See this image and copyright information in PMC

References

    1. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52: e162–e193. - PMC - PubMed
    1. Lamontagne F, McIntyre L, Dodek P, et al. Nonleg venous thrombosis in critically ill adults. JAMA Intern Med 2014; 174: 689. - PubMed
    1. Young AM, Billingham LJ, Begum G, et al. Warfarin thromboprophylaxis in cancer patients with central venous catheters (WARP): an open-label randomised trial. Lancet 2009; 373: 567–574. - PubMed
    1. Lavau-Denes S, Lacroix P, Maubon A, et al. Prophylaxis of catheter-related deep vein thrombosis in cancer patients with low-dose warfarin, low molecular weight heparin, or control: a randomized, controlled, phase III study. Cancer Chemother Pharmacol 2013; 72: 65–73. - PubMed
    1. Kovacs MJ, Kahn SR, Rodger M, et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost 2007; 5: 1650–1653. - PubMed

Publication types