Is there a role for intervention radiology for the treatment of lower limb deep vein thrombosis in the era of direct oral anticoagulants? A comprehensive review

A 75-year-old woman with a history of intracranial haemorrhage, atrial fibrillation and coronary artery bypass graft underwent elective left atrial appendage occlusion (LAAO) for stroke prevention. The procedure was successful, however on the third postoperative day, she presented with a lymph leak at the right femoral venous access site. She was admitted for conservative management of the lymph leak with immobility and intravenous fluids. Her inpatient stay was complicated by a right lower limb deep vein thrombosis (DVT), left middle cerebral artery territory ischaemic stroke, pulmonary emboli (PEs) and a splenic infarction. The mechanism of the systemic emboli was that of paradoxical emboli from the DVT passing through an interatrial septal defect created as part of the LAAO procedure, a previously unreported complication of LAAO. She was managed with 6 months of low-dose oral anticoagulation for treatment of DVT and PE and has made a full neurological recovery.

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Variability in the management of line-related upper extremity deep vein thrombosis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519827155 ◽

2019 ◽

Vol 34 (8) ◽

pp. 552-558 ◽

Cited By ~ 1

Author(s):

Rafael Cires-Drouet ◽

Jashank Sharma ◽

Tara McDonald ◽

John D Sorkin ◽

Brajesh K Lal

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Exact Test ◽

Medical Specialists ◽

Vein Thrombosis ◽

Deep Vein ◽

Question Survey

Objectives Central-venous devices are risk-factors for upper extremity deep vein thrombosis. We surveyed physicians to identify practice-patterns and adherence to American College of Chest Physicians guidelines. Methods The 13-question survey obtained physician-demographics and treatment-choices. Respondents were grouped into surgical and medical specialists. Data were reported as ratios and percentages, and compared using Fisher’s exact test. Results We received 143 responses from physicians; 65% treated one-to-two new cases/month. Most physicians (69.2%) used anticoagulation; 36.4% retained the catheter and 32.9% removed it. Medical-specialists retained catheters more often than surgeons ( p = 0.027). For recurrences, 84% repeated anticoagulation; 50.3% retained the catheter. A majority anticoagulated upper-extremity deep-vein thrombosis in long-term catheters for three months only (55.1%). Direct oral anticoagulants were used frequently (43.6%). Only 10% believed that existing guidelines were appropriate and only 2.8% followed all guidelines. Conclusion There is great variability in treatment-decisions for upper-extremity deep-vein thrombosis. The existing guidelines are considered inadequate and not followed by most physicians.

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Policy Change for Deep Vein Thrombosis: Effects on Length of Stay and Hospitalization Costs of Moving From Warfarin to Direct Oral Anticoagulants

Clinical Therapeutics ◽

10.1016/j.clinthera.2018.12.006 ◽

2019 ◽

Vol 41 (2) ◽

pp. 269-279 ◽

Cited By ~ 1

Author(s):

Adam D. Porath ◽

Sharon Clodfelter ◽

Terra Slaton ◽

Brahim K. Bookhart ◽

Chris M. Kozma ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Length Of Stay ◽

Policy Change ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Vein Thrombosis ◽

Hospitalization Costs ◽

Deep Vein

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Presence of Lower Limb Deep Vein Thrombosis and Prognosis in Patients with Symptomatic Pulmonary Embolism: Preliminary Report

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2008.08.018 ◽

2009 ◽

Vol 37 (2) ◽

pp. 225-231 ◽

Cited By ~ 29

Author(s):

T. Yamaki ◽

M. Nozaki ◽

H. Sakurai ◽

M. Takeuchi ◽

K. Soejima ◽

...

Keyword(s):

Pulmonary Embolism ◽

Deep Vein Thrombosis ◽

Lower Limb ◽

Preliminary Report ◽

Vein Thrombosis ◽

Symptomatic Pulmonary Embolism ◽

Deep Vein ◽

Limb Deep Vein Thrombosis

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Upper extremities deep vein thrombosis and DOAC treatment: a prospective cohort study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2407 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.C Vedovati ◽

G Tratar ◽

A Mavri ◽

L Pierpaoli ◽

G Agnelli ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Oral Anticoagulants ◽

Direct Oral Anticoagulants ◽

Pacemaker Implantation ◽

Limb Ischemia ◽

Central Venous Line ◽

Upper Extremities ◽

Acute Limb Ischemia ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background Data on the use of direct oral anticoagulants (DOACs) in patients with upper extremities deep vein thrombosis (UEDVT) are limited. Purpose To assess the effectiveness and safety of DOACs in the treatment of UEDVT. Methods Data on patients with an objective diagnosis of acute UEDVT treated with DOACs were merged from prospective cohorts of patients with venous thromboembolism (VTE). Study outcomes were recurrent VTE and major bleeding (MB) occurring during DOAC treatment. Results Overall, 132 patients were included: mean age was 47.7±18.0 years (range 18 to 97), males were 42.4%. Twenty-seven percent of patients had 2 or more risk factors for VTE, 29.5% had UEDVT complicating a central venous line or after pacemaker implantation (Table). Ninety-two patients (70%) were managed as outpatients. Increased age (OR 1.03, 95% CI 1.0–1.05) and anemia (OR 1.35, 95% CI 1.07–1.70) were associated with in-patient management. Among patients treated with apixaban (40) or rivaroxaban (85) loading dose was used in 72%; in patients treated with dabigatran (5) or edoxaban (2) mean heparin pre-treatment was 8 days. DOACs were started after 1 month from UEDVT diagnosis in 12.9% of patients; active cancer was a main predictor for delayed initiation (OR 22.2, 95% CI 5.8–84.4). Mean treatment duration in patients with a scheduled stop was 4.9 months, while mean followup in those who continued DOACs was 9.3 months. No recurrence of VTE nor MBs occurred during DOAC treatment; one patient had acute limb ischemia (1.38% patient-year), 7 clinically relevant non-MBs (3 genital, 2 epistaxis, 1 gingival, 1 genital bleeding plus epistaxis; 10.51% patient-year), 5 deaths (4 cancer, 1 advanced age; 9.69% patient-year). Conclusions Our data support the effectiveness and safety of DOACs for the treatment of acute UEDVT. Further studies are required to confirm these findings. Funding Acknowledgement Type of funding source: None

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