Chapter 149 - Acute UE venous thrombosis

Question 1

Classes of UEDVT and two causes of each

Answer 1

Primary UEDVT 1) effort thrombosis (Paget Schroetter) 2) idiopathic Secondary UEDVT 1) cancer 2) indwelling CVC

Question 2

RIETE Computerized registry of patients with VTE on UEDVT

Answer 2

4.4% in registry 50% catheter related higher mortality than LEDVT 48 vs 13% at 6 months (due to comorbidities)

Question 3

Symptoms of UEDVT

Answer 3

1) erythema 2) pain 3) swelling 4) chest wall vein engorgement 5) phlegmasia cerulean dolens

Question 4

Rate of PE after UEDVT

Answer 4

5-20%

Question 5

PTS rate in UEDVT

Answer 5

4-35%

Question 6

Limitations of US to detect UEDVT

Answer 6

1) proximal subclavian 2) brachiocephalic vein Adjunctive imaging may be needed if clinical suspicion doesn’t match US finding

Question 7

Kleinjan 2014 UEDVT clinical decision criteria

Answer 7

1) catheter 2) localized pain 3) unilateral edema -1 if another diagnosis possible points 1 - 12% risk 2 - 20% 3 - 70%

Question 8

Boersma on catheter related venous thrombosis biomarker correlation

Answer 8

1) Factor VIII 2) WBC elevation 3) PAI-1 elevation

Question 9

Timset 1998 risk of UEDVT

Answer 9

1) age > 65 2) IJ vein use for catheter 3) absence of therapeutic AC at time of catheter

Question 10

role of AC prophylaxis in catheters

Answer 10

no evidence to support

Question 11

Catheter-related risk of UEDVT

Answer 11

1) polyethylene instead of polyurethane catheters 2) rigid instead of compliant catheters 3) less trauma to wall during insertion 4) ensure optimal positioning 5) size of catheter 6) multiple puncture attempts 7) overall duration

Question 12

Role of heparin bound catheters

Answer 12

inconclusive no evidence

Question 13

PICC risk of UEDVT

Answer 13

1.6-3.5%

Question 14

Risk of UEDVT with pacemaker multi lead vs single lead

Answer 14

27% vs 7%

Question 15

Optimal location of the tip of all CVC

Answer 15

Junction of right atrium and SVC

Question 16

Risk of UEDVT with left sided or right sided CVC

Answer 16

Left: 25.6% Right 6.8%

Question 17

Route of insertion and risk of UEDVT IJ, subclavian, femoral

Answer 17

Femoral much worse IJ = subclavian

Question 18

Treatment algorithm for acute UEDVT

Answer 18

FIGURE 149.1

Question 19

2016 CHEST GUIDELINES on UEDVT CDT

Answer 19

CDT benefit those with 1) severe symptoms 2) thrombus in most subclavian and axillary veins 3) symptoms < 14 days 4) good functional status 5) life expectancy > 1 year 6) low risk for bleeding

Question 20

Duration of anticoagulation for UEDVT

Answer 20

3-6 months full anticoagulation