What is the treatment for a probable occlusion of the left internal jugular vein due to thrombosis, as indicated by an ultrasound (US) scan?

From the Guidelines

For a probable occluded left jugular vein due to thrombosis, the recommended treatment is anticoagulation therapy, starting with low molecular weight heparin, as it is the preferred initial treatment according to the most recent guidelines 1. The treatment approach should prioritize anticoagulation to prevent clot propagation and allow the body's natural fibrinolytic system to dissolve the existing clot.

• The initial anticoagulation treatment usually involves low molecular weight heparin, followed by vitamin K antagonists, except in patients with cancer and patients with poor oral absorption, for whom low molecular weight heparin is preferred 1.
• The length of time a patient should be anticoagulated will depend on individual case characteristics, but generally is 3-6 months and in some cases forever 1.
• Thrombolytic agents are not usually employed in upper limb thrombosis, except in cases of massive thrombosis with severe symptoms and signs, if the bleeding risk is low and the thrombus is recent (less than ten days long) 1.
• Catheter removal is generally warranted when it is infected or occluded, if there is contraindication to anticoagulation treatment, or if there are persistent symptoms and signs despite anticoagulation 1. The goal of treatment is to prevent pulmonary embolism and post-thrombotic syndrome, and recanalization of the vein typically occurs within weeks to months.
• Monitoring for bleeding complications is crucial, and consideration of thrombolysis or thrombectomy may be necessary for severe cases with significant swelling or compromised cerebral circulation.
• Elevating the head of the bed and applying warm compresses can help reduce swelling.
• The decision to remove or maintain the catheter will be based on each individual situation, taking into account the risk factors, extent and characteristics of the thrombus, and catheter removal 1.

From the Research

Treatment Options for Jugular Vein Thrombosis

• Anticoagulation therapy is a common treatment approach for jugular vein thrombosis, as seen in studies 2, 3, 4, 5, 6
• The use of heparin, including unfractionated heparin and low-molecular-weight heparin, has been recommended for the treatment of venous thromboembolism, including jugular vein thrombosis 2, 5
• Direct oral anticoagulants (DOACs) are also considered a treatment option for jugular vein thrombosis, particularly in cases where antithrombotic treatment is advisable 4
• In cases of sepsis, surgery may be necessary to control the focus 4

Diagnosis and Symptomatology

• Sonography is the diagnostic tool of choice for jugular vein thrombosis, which can be complemented by CT/MRI if necessary 4
• Clinical symptoms of jugular vein thrombosis often include neck pain, headache, swelling, erythema, and the palpable cord sign beneath the sternocleidomastoid muscle, frequently associated with fever 6
• Ultrasound of the neck is a quick, economic, cost-effective, noninvasive tool for diagnosis 6

Etiology and Risk Factors

• Jugular vein thrombosis can be caused by various factors, including inflammatory, traumatic, and (para-)neoplastic diseases 4
• Central vein catheterization is also a reported cause of jugular vein thrombosis 6
• Lemierre's syndrome is a rare condition that can cause septic thrombophlebitis of the internal jugular vein, and anticoagulation therapy may be considered in high-risk patients 3