Abstract Number: PB2392
Meeting: ISTH 2020 Congress
Background: Despite peripheral catheter-related upper extremity superficial vein thrombosis (PCRUESVT) being relatively common, the optimal treatment strategy to avoid thrombus extension is not known.
Aims: To describe PCRUESVT risk factors, management strategies, complications and rates of radiologically confirmed extension.
Methods: We reviewed all patients diagnosed with symptomatic, PCRUESVT from March 2015 to December 2017 at Monash Health, Melbourne. Patients with a central catheter or concurrent indication for anticoagulation were excluded. The primary outcomes were the effect of identified risk factors and PCRUESVT management on rates of ISTH-defined bleeding and radiologically confirmed thrombus resolution or extension.
Results: Of 93 patients included, 54 were male (51%), median age 57 years (range 20-91). PCRUESVT characteristics, management and outcomes are shown in Table 1. PCRUESVT risk factors identified included underlying cancer (25%) and infection (28%). 73% involved a single segment ≥5cm and 63% were proximal to the cubital fossa. 69% were admitted at diagnosis and therefore continued on prophylactic anticoagulation. 28 cases (30%) had 1-3 repeat scans. Compared to group 1, all thrombus resolution occurred in group 2 (0vs25% RR1.44 95%CI: 0.2-10.7) and group 3 (0vs36% RR1.27 95%CI: 0.2-9.3) whilst only group 3 had radiologically confirmed extension (0vs8% RR1.67 95%CI: 0.2-12) and bleeding (0vs4% RR1.9 95%CI: 0.26-13.4). All cases of extension/bleeding had active malignancy and extension only occurred in thrombi ≥ 5cm in length.
Conclusions: PCRUESVT management is variable and ranged from observation/symptomatic treatment to prophylactic and intermediate/therapeutic dose anticoagulation. The rates of superficial and deep extension were both low at 1% (95%CI: 0.2-5.9). Both thrombus extension and bleeding only occurred in patients with active cancer who received intermediate/therapeutic anticoagulation.
|Group 1 Observation or symptomatic relief n=34||Group 2 Prophylactic dose anticoagulation n=35||Group 3 Intermediate or therapeutic dose anticoagulation n=24|
|No cancer or infection, %||43||34||23|
|Thrombus single segment ≥5cm, %||27||69||77|
|Thrombus proximal to cubital fossa, %||64||72||42|
|Treatment duration (weeks, median range)||NA||1.07 (0.1‐25)||3 (0.6‐31.9)|
|Bleeding, % (95%CI)||0||0||4 (0.1‐21)|
|Extension, % (95%CI)||0||0||8 (1‐27)|
[Table 1. PCRUESVT characteristics, management and outcomes]
To cite this abstract in AMA style:Yuen HLA, Fang W, Chunilal S. Variability of Management of Peripheral Catheter-Related Upper Extremity Superficial Vein Thrombosis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/variability-of-management-of-peripheral-catheter-related-upper-extremity-superficial-vein-thrombosis/. Accessed May 16, 2022.
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