From the Guidelines
Management of upper extremity deep vein thrombosis (UEDVT) primarily involves anticoagulation therapy for 3 months, as recommended by the most recent guidelines 1. The initial treatment should begin with low molecular weight heparin such as enoxaparin 1 mg/kg twice daily or fondaparinux 7.5 mg daily (dose adjusted for weight and renal function), overlapping with warfarin (target INR 2-3) for at least 5 days until therapeutic INR is achieved. Alternatively, direct oral anticoagulants (DOACs) like rivaroxaban (15 mg twice daily for 21 days, then 20 mg daily), apixaban (10 mg twice daily for 7 days, then 5 mg twice daily), or edoxaban (60 mg daily after 5-10 days of parenteral anticoagulation) can be used, as suggested by previous guidelines 1. For catheter-related UEDVT, the catheter should be removed if no longer needed; however, if still required, it can remain in place with anticoagulation, as stated in the guidelines 1. Thrombolysis is reserved for severe cases with limb-threatening ischemia or massive thrombosis, and anticoagulant therapy alone is suggested over thrombolysis in most cases 1. Superior vena cava filters are rarely indicated and should only be considered when anticoagulation is contraindicated. Some key points to consider in the management of UEDVT include:
- Compression sleeves may help manage symptoms but aren't proven to prevent post-thrombotic syndrome
- Early mobilization and elevation of the affected limb are recommended to reduce swelling
- Patients should be monitored for complications including pulmonary embolism, post-thrombotic syndrome, and recurrent thrombosis, with follow-up imaging typically performed after 3 months of therapy to confirm resolution. The most recent guidelines 1 recommend a 3-month treatment phase of anticoagulation, and upon completion of this phase, all patients should be assessed for extended-phase therapy.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Management Guidelines for Upper Extremity Deep Vein Thrombosis (DVT)
- The management of upper extremity DVT is largely derived from evidence for treatment of lower extremity DVT, with international guidelines recommending anticoagulant treatment for at least three months 2.
- Anticoagulant treatment options include vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs), such as apixaban and rivaroxaban 2, 3.
- The use of low-dose DOACs, such as apixaban 2.5 mg twice daily or rivaroxaban 10 mg daily, may be effective for extended anticoagulant therapy in patients with persistent thrombotic risk factors or without recanalization of the UEDVT 2.
- Catheter-directed thrombolysis or surgery may also be considered as treatment options, particularly in patients with primary upper extremity DVT, as they may help reduce the risk of post-thrombotic syndrome (PTS) or recurrent venous thromboembolism 4.
- Treatment with dalteparin sodium followed by warfarin or dalteparin sodium monotherapy for 3 months has also been shown to be effective and safe in patients with upper extremity DVT 5.
- Long-term anticoagulation is recommended for patients with UEDVT, if there are no contraindications, to reduce the occurrence of complications 6.
Treatment Outcomes
- Studies have reported low rates of recurrent venous thromboembolism and bleeding complications with anticoagulant treatment, including DOACs and VKAs 2, 3, 5.
- The incidence of PTS may be reduced with more aggressive treatments, such as catheter-directed thrombolysis or surgery, in patients with primary upper extremity DVT 4.
- Major and minor bleeding complications have been reported with anticoagulant treatment, but the rates are generally low 2, 3, 5.