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DOI: 10.1055/a-1669-3336
Treatment of Atypical Clots
Abstract
The term unusual site thrombosis refers to the occurrence of venous thromboembolism outside of the lower limbs and the pulmonary arteries. Unusual site thrombosis can virtually affect any venous segment, with the most common and/or clinically relevant sites including the upper limbs veins, the retinal veins, the splanchnic veins and the cerebral veins. Clinical features are obviously heterogeneous, while many predisposing factors are common, though with different prevalence among the various disorders. Antithrombotic therapy is prescribed to most patients, but the type, intensity, and duration of treatment vary both within and among patient groups. Increasing evidence is supporting the use of the direct oral anticoagulants in patients with upper limb deep vein thrombosis, cerebral vein thrombosis, and with splanchnic vein thrombosis. This article will review available evidence on the treatment of venous thrombosis occurring in unusual sites.
Publication History
Received: 21 August 2021
Accepted: 12 October 2021
Article published online:
23 February 2022
© 2022. Thieme. All rights reserved.
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References
- 1 Lindblad B, Sternby NH, Bergqvist D. Incidence of venous thromboembolism verified by necropsy over 30 years. BMJ 1991; 302 (6778): 709-711
- 2 Ageno W, Haas S, Weitz JI. et al. Upper extremity DVT versus lower extremity DVT: perspectives from the GARFIELD-VTE registry. Thromb Haemost 2019; 119 (08) 1365-1372
- 3 Arnhjort T, Persson LM, Rosfors S, Ludwigs U, Lärfars G. Primary deep vein thrombosis in the upper limb: a retrospective study with emphasis on pathogenesis and late sequelae. Eur J Intern Med 2007; 18 (04) 304-308
- 4 Levy MM, Bach C, Fisher-Snowden R, Pfeifer JD. Upper extremity deep venous thrombosis: reassessing the risk for subsequent pulmonary embolism. Ann Vasc Surg 2011; 25 (04) 442-447
- 5 Tadlock MD, Chouliaras K, Kennedy M. et al. The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients. Am J Surg 2015; 209 (06) 959-968
- 6 Newton DH, Monreal Bosch M, Amendola M. et al; RIETE Investigators. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5 (01) 18.e1-24.e1
- 7 Houghton DE, Casanegra AI, Peterson LG. et al. Treatment of upper extremity deep vein thrombosis with apixaban and rivaroxaban. Am J Hematol 2020; 95 (07) 817-823
- 8 Beiswenger AC, Quereshy HA, Rouabhi M. et al. Midterm outcomes in patients with upper extremity deep vein thrombosis. J Vasc Surg Venous Lymphat Disord 2020; 8 (06) 930.e2-938.e2
- 9 Bleker SM, van Es N, Kleinjan A. et al. Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis. J Thromb Haemost 2016; 14 (05) 973-981
- 10 Delluc A, Le Gal G, Scarvelis D, Carrier M. Outcome of central venous catheter associated upper extremity deep vein thrombosis in cancer patients. Thromb Res 2015; 135 (02) 298-302
- 11 Fan F, Zou Y, Zhang S. et al. Rivaroxaban in the treatment of PICC-associated upper extremity venous thrombosis. Clin Ther 2017; 39 (09) 1882-1888
- 12 Laube ES, Mantha S, Samedy P, Wills J, Harnicar S, Soff GA. Treatment of central venous catheter-associated deep venous thrombosis in cancer patients with rivaroxaban. Am J Hematol 2017; 92 (01) E9-E10
- 13 Kovacs MJ, Kahn SR, Rodger M. et al. A pilot study of central venous catheter survival in cancer patients using low-molecular-weight heparin (dalteparin) and warfarin without catheter removal for the treatment of upper extremity deep vein thrombosis (The Catheter Study). J Thromb Haemost 2007; 5 (08) 1650-1653
- 14 Davies GA, Lazo-Langner A, Gandara E. et al. A prospective study of rivaroxaban for central venous catheter associated upper extremity deep vein thrombosis in cancer patients (Catheter 2). Thromb Res 2018; 162: 88-92
- 15 Rathbun SW, Stoner JA, Whitsett TL. Treatment of upper-extremity deep vein thrombosis. J Thromb Haemost 2011; 9 (10) 1924-1930
- 16 Porfidia A, Agostini F, Giarretta I. et al. Upper extremity deep vein thrombosis treated with direct oral anticoagulants: a multi-center real world experience. J Thromb Thrombolysis 2020; 50 (02) 355-360
- 17 Frank DA, Meuse J, Hirsch D, Ibrahim JG, van den Abbeele AD. The treatment and outcome of cancer patients with thromboses on central venous catheters. J Thromb Thrombolysis 2000; 10 (03) 271-275
- 18 Prandoni P, Bernardi E, Marchiori A. et al. The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study. BMJ 2004; 329 (7464): 484-485
- 19 Kearon C, Akl EA, Ornelas J. et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
- 20 Kahn SR, Galanaud JP, Vedantham S, Ginsberg JS. Guidance for the prevention and treatment of the post-thrombotic syndrome. J Thromb Thrombolysis 2016; 41 (01) 144-153
- 21 Ageno W, Riva N, Schulman S. et al; IRSVT study group. Antithrombotic treatment of splanchnic vein thrombosis: results of an international registry. Semin Thromb Hemost 2014; 40 (01) 99-105
- 22 Ageno W, Riva N, Schulman S. et al. Long-term clinical outcomes of splanchnic vein thrombosis: results of an international registry. JAMA Intern Med 2015; 175 (09) 1474-1480
- 23 Delgado MG, Seijo S, Yepes I. et al. Efficacy and safety of anticoagulation on patients with cirrhosis and portal vein thrombosis. Clin Gastroenterol Hepatol 2012; 10 (07) 776-783
- 24 Turnes J, García-Pagán JC, González M. et al. Portal hypertension-related complications after acute portal vein thrombosis: impact of early anticoagulation. Clin Gastroenterol Hepatol 2008; 6 (12) 1412-1417
- 25 Di Nisio M, Valeriani E, Riva N, Schulman S, Beyer-Westendorf J, Ageno W. Anticoagulant therapy for splanchnic vein thrombosis: ISTH SSC Subcommittee Control of Anticoagulation. J Thromb Haemost 2020; 18 (07) 1562-1568
- 26 Riva N, Ageno W. Direct oral anticoagulants for unusual-site venous thromboembolism. Res Pract Thromb Haemost 2021; 5 (02) 265-277
- 27 Simonetto DA, Singal AK, Garcia-Tsao G, Caldwell SH, Ahn J, Kamath PS. ACG clinical guideline: disorders of the hepatic and mesenteric circulation. Am J Gastroenterol 2020; 115 (01) 18-40
- 28 Northup PG, Garcia-Pagan JC, Garcia-Tsao G. et al. Vascular liver disorders, portal vein thrombosis, and procedural bleeding in patients with liver disease: 2020 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2021; 73 (01) 366-413
- 29 Garcia DA, Baglin TP, Weitz JI, Samama MM. Parenteral anticoagulants: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2, Suppl): e24S-e43S
- 30 Kearon C, Akl EA, Comerota AJ. et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012; 141 (2, Suppl): e419S-e496S
- 31 Key NS, Khorana AA, Kuderer NM. et al. Venous thromboembolism prophylaxis and treatment in patients with cancer: ASCO clinical practice guideline update. J Clin Oncol 2020; 38 (05) 496-520
- 32 Cohen O, Caiano LM, Tufano A, Ageno W. Cancer-associated splanchnic vein thrombosis. Semin Thromb Hemost 2021; 47 (08) 931-941
- 33 Tufano A, Ageno W, Di Micco P. et al; RIETE Investigators. Outcomes during anticoagulation in patients with symptomatic vs. incidental splanchnic vein thrombosis. Thromb Res 2018; 164: 69-74
- 34 Cheng Q, Tree K. Systematic review of thrombolysis therapy in the management of non-cirrhosis-related portal vein thrombosis. J Gastrointest Surg 2021; 25 (06) 1579-1590
- 35 DeLeve LD, Valla DC, Garcia-Tsao G. American Association for the Study Liver Diseases. Vascular disorders of the liver. Hepatology 2009; 49 (05) 1729-1764
- 36 Cohen O, Pegoraro S, Ageno W. Cerebral venous thrombosis. Minerva Med 2021; . ( e-pub ahead of print) DOI: 10.23736/S0026-4806.21.07353-5.
- 37 Bousser MG, Ferro JM. Cerebral venous thrombosis: an update. Lancet Neurol 2007; 6 (02) 162-170
- 38 Ferro JM, Bousser MG, Canhão P. et al; European Stroke Organization. European Stroke Organization guideline for the diagnosis and treatment of cerebral venous thrombosis - endorsed by the European Academy of Neurology. Eur J Neurol 2017; 24 (10) 1203-1213
- 39 Coutinho JM, Ferro JM, Zuurbier SM. et al. Thrombolysis or anticoagulation for cerebral venous thrombosis: rationale and design of the TO-ACT trial. Int J Stroke 2013; 8 (02) 135-140
- 40 Saposnik G, Barinagarrementeria F, Brown Jr RD. et al; American Heart Association Stroke Council and the Council on Epidemiology and Prevention. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2011; 42 (04) 1158-1192
- 41 Ferro JM, Coutinho JM, Dentali F. et al; RE-SPECT CVT Study Group. Safety and efficacy of dabigatran etexilate vs dose-adjusted warfarin in patients with cerebral venous thrombosis: a randomized clinical trial. JAMA Neurol 2019; 76 (12) 1457-1465
- 42 Miranda B, Aaron S, Arauz A. et al. The benefit of EXtending oral antiCOAgulation treatment (EXCOA) after acute cerebral vein thrombosis (CVT): EXCOA-CVT cluster randomized trial protocol. Int J Stroke 2018; 13 (07) 771-774
- 43 Hayreh SS, Zimmerman MB, Beri M, Podhajsky P. Intraocular pressure abnormalities associated with central and hemicentral retinal vein occlusion. Ophthalmology 2004; 111 (01) 133-141
- 44 Raslan OM, Lazo-Langner A. Treatment of retinal vein thrombosis: what about anticoagulants?. Minerva Med 2021; . ( e-pub ahead of print) DOI: 10.23736/S0026-4806.21.07474-7.
- 45 Pulido JS, Flaxel CJ, Adelman RA, Hyman L, Folk JC, Olsen TW. Retinal vein occlusions preferred practice Pattern(®) guidelines. Ophthalmology 2016; 123 (01) 182-208
- 46 Schmidt-Erfurth U, Garcia-Arumi J, Gerendas BS. et al. Guidelines for the management of retinal vein occlusion by the European Society of Retina Specialists (EURETINA). Ophthalmologica 2019; 242 (03) 123-162
- 47 Ageno W, Beyer-Westendorf J, Garcia DA, Lazo-Langner A, McBane RD, Paciaroni M. Guidance for the management of venous thrombosis in unusual sites. J Thromb Thrombolysis 2016; 41 (01) 129-143
- 48 Lazo-Langner A, Hawel J, Ageno W, Kovacs MJ. Low molecular weight heparin for the treatment of retinal vein occlusion: a systematic review and meta-analysis of randomized trials. Haematologica 2010; 95 (09) 1587-1593
- 49 Belcaro G, Dugall M, Bradford HD. et al. Recurrent retinal vein thrombosis: prevention with Aspirin, Pycnogenol®, ticlopidine, or sulodexide. Minerva Cardioangiol 2019; 67 (02) 109-114
- 50 Rodriguez P, Belcaro G, Dugall M. et al. Recurrence of retinal vein thrombosis with Pycnogenol® or Aspirin® supplementation: a registry study. Panminerva Med 2015; 57 (03) 121-125
- 51 Shi W, Dowell JD. Etiology and treatment of acute inferior vena cava thrombosis. Thromb Res 2017; 149: 9-16
- 52 Watson L, Broderick C, Armon MP. Thrombolysis for acute deep vein thrombosis. Cochrane Database Syst Rev 2016; 11: CD002783
- 53 Vedantham S, Goldhaber SZ, Julian JA. et al; ATTRACT Trial Investigators. Pharmacomechanical catheter-directed thrombolysis for deep-vein thrombosis. N Engl J Med 2017; 377 (23) 2240-2252
- 54 Comerota AJ, Kearon C, Gu CS. et al; ATTRACT Trial Investigators. Endovascular thrombus removal for acute iliofemoral deep vein thrombosis. Circulation 2019; 139 (09) 1162-1173
- 55 Alkhouli M, Zack CJ, Zhao H, Shafi I, Bashir R. Comparative outcomes of catheter-directed thrombolysis plus anticoagulation versus anticoagulation alone in the treatment of inferior vena caval thrombosis. Circ Cardiovasc Interv 2015; 8 (02) e001882
- 56 Asghar M, Ahmed K, Shah SS, Siddique MK, Dasgupta P, Khan MS. Renal vein thrombosis. Eur J Vasc Endovasc Surg 2007; 34 (02) 217-223
- 57 Kodali N, Veytsman I, Martyr S, Lu K. Diagnosis and management of ovarian vein thrombosis in a healthy individual: a case report and a literature review. J Thromb Haemost 2017; 15 (02) 242-245
- 58 Bannow BTS, Skeith L. Diagnosis and management of postpartum ovarian vein thrombosis. Hematology (Am Soc Hematol Educ Program) 2017; 2017 (01) 168-171