Data on vena cava filters are limited
Data supporting superior vena cava Green-field filters to treat UEVT are extremely limited. Of 6 patients with contraindications to anticoagulation therapy who were treated with a Greenfield filter, none had clinical evidence of pulmonary embolism at 14 months.6 The study reported no data regarding long-term sequelae or effects of the UEVT on the patients’ upper extremity.6
When in doubt, don’t (necessarily) take it out
For patients with central venous catheter-related deep vein thrombosis, taking out the catheter as part of treatment is controversial and should depend on clinical symptoms, the reason for the catheter, and duration of use, as well as physician judgment.7 No RCTs have studied the effects of catheter removal as part of initial treatment. Current guidelines recommend removing the catheter from patients with persistent symptoms who have failed anticoagulant or thrombolytic treatment.1
Recommendations
The American College of Chest Physicians recommends therapeutic doses of intravenous unfractionated heparin, low-molecular-weight heparin, or fondaparinux for initial treatment of UEVT, followed by at least 3 months of treatment with a vitamin K antagonist.1 The organization also suggests that surgical thrombectomy, superior vena caval filters, thrombolytic therapy, or catheter extraction may benefit selected patients.
Acknowledgement
The opinions and assertions contained herein are the private views of the author and not to be construed as official, or as reflecting the views of the US Air Force Medical Service or the US Air Force at large.