From the Guidelines
Upper extremity superficial venous thrombosis should be treated with symptomatic management, including warm compresses, nonsteroidal anti-inflammatory drugs, and elevation of the affected limb, with consideration of prophylactic dose anticoagulation if there is symptomatic progression or progression on imaging, as recommended by the NCCN clinical practice guidelines in oncology 1. The treatment approach for upper extremity superficial venous thrombosis (SVT) involves a step-wise strategy, starting with removal of any involved peripheral catheter if no longer indicated 1. For patients with SVT associated with a PICC line, catheter removal may not be necessary if the patient is treated with anticoagulation and/or symptoms resolve 1. Symptomatic treatment, including warm compresses, nonsteroidal anti-inflammatory drugs, and elevation of the affected limb, should be used as clinically indicated 1. Key considerations in the treatment of upper extremity SVT include:
- Symptomatic management with warm compresses, nonsteroidal anti-inflammatory drugs, and elevation 1
- Prophylactic dose anticoagulation with rivaroxaban 10 mg by mouth daily or fondaparinux 2.5 mg subcutaneous daily for 45 days if there is symptomatic progression or progression on imaging 1
- Avoidance of aspirin and nonsteroidal anti-inflammatory drugs in patients with platelet counts less than 20,000 to 50,000/mcL or with severe platelet dysfunction 1
- Monitoring for extension into the deep venous system, which would require more aggressive anticoagulation 1.
From the Research
Upper Extremity Superficial Venous Thrombosis Treatment
- The treatment of upper extremity superficial venous thrombosis (UESVT) is not as well-studied as deep vein thrombosis (DVT) or superficial vein thrombosis (SVT) of the lower limbs 2, 3.
- A study on UESVT found that anticoagulant treatment was started in 73% of patients, and only one patient had a recurrent VTE, while 33% of patients died 4.
- The management of SVT, which includes UESVT, aims at symptom relief and prevention of venous thromboembolism (VTE) 2, 3.
- Therapeutic options for SVT include topical preparations, compression therapy, non-steroidal anti-inflammatory drugs (NSAIDs), anticoagulants, and surgery 3.
- Low molecular weight heparin or fondaparinux are considered as treatment options for SVT, with fondaparinux showing a lower event rate of DVT or PE in a meta-analysis 5.
- The optimal treatment for UESVT is still unknown, and more studies are needed to define the best management strategies 2, 5.
- A study on the outpatient use of low molecular weight heparin (dalteparin) for the treatment of upper extremity DVT showed that it is safe and effective 6.
- However, the study on dalteparin was focused on DVT, and its applicability to UESVT is not clear 6.