Advertisement

Controversies in VTOS: How Long Should Anticoagulation Be Used in VTOS?

  • Hugh A. Gelabert
Chapter

Abstract

Anticoagulation is an important element in the management of most patients with VTOS. The use of anticoagulation should be tailored to the specific form of VTOS present, however, and modified according to the condition of the individual patient. In general, patients with non-thormbotic positional venous compression requires no anticoagulation. Those with acute axillosubclavian vein thrombosis require anticoagulation to prevent propagation of thrombus, reduce the risk of pulmonary embolus, and to reduce the risk of rethrombosis while awaiting decompression, and following this should be anticoagulated for 3 months. Patients with chronic venous occlusion do not require anticoagulation for safety, but long-term anticoagulation may be associated with spontaneous recanalization and thus can be considered.

Keywords

Deep Vein Thrombosis Subclavian Vein Surgical Decompression Recurrent Thrombosis Venous Compression 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Marks J. Anticoagulant therapy in the idiopathic ­occlusion of the axillary vein. Br Med J. 1956;1(4957):11–3.PubMedCrossRefGoogle Scholar
  2. 2.
    Marks J, Truscott BM, Withycombe JF. Treatment of venous thrombosis with anticoagulants; review of 1135 cases. Lancet. 1954;267(6842):787–91.PubMedCrossRefGoogle Scholar
  3. 3.
    Adams JT, De Weese JA. Effort thrombosis of the axillary and subclavian veins. J Trauma. 1971;11:923–30.PubMedCrossRefGoogle Scholar
  4. 4.
    Tilney NL, Griffiths HJG, Edwards EA. Natural history of major venous thrombosis of the upper extremity. Arch Surg. 1970;101:792–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Machleder HI. Evaluation of a new treatment strategy for Paget-Schroetter syndrome: spontaneous thrombosis of the axillary-subclavian vein. J Vasc Surg. 1993;17(2):305–15; discussion 316–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Kooij JD, van der Zant FM, van Beek EJ, Reekers JA. Pulmonary embolism in deep venous thrombosis of the upper extremity: more often in catheter-related thrombosis. Neth J Med. 1997;50(6):238–42.PubMedCrossRefGoogle Scholar
  7. 7.
    Monreal M, Lafoz E, Ruiz J, Valls R, Alastrue A. Upper-extremity deep venous thrombosis and pulmonary embolism. A prospective study. Chest. 1991;99(2):280–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Kearon C, Kahn SR, Agnelli G, Goldhaber SZ, Raskob G, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: ACCP evidence-based clinical practice guidelines (8th edition). Chest. 2008;133:454S–545.PubMedCrossRefGoogle Scholar
  9. 9.
    Kunkel JM, Machleder HI. Treatment of Paget-Schroetter syndrome. A staged, multidisciplinary approach. Arch Surg. 1989;124(10):1153–7; discussion 1157–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Angle N, Gelabert HA, Farooq MM, Ahn SS, Caswell DR, Freischlag JA, Machleder HI. Safety and efficacy of early surgical decompression of the thoracic outlet for Paget-Schroetter syndrome. Ann Vasc Surg. 2001;15(1):37–42.PubMedGoogle Scholar
  11. 11.
    Vayá A, Mira Y, Mateo J, Falco C, Villa P, Estelles A, Corella D, Fontcuberta J, Aznar J. Prothrombin G20210A mutation and oral contraceptive use increase upper-extremity deep vein thrombotic risk. Thromb Haemost. 2003;89(3):452–7.PubMedGoogle Scholar
  12. 12.
    Martinelli I, Battaglioli T, Bucciarelli P, Passamonti SM, Mannucci PM. Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities. Circulation. 2004;110(5):566–70. Epub 2004 Jul 19.PubMedCrossRefGoogle Scholar
  13. 13.
    Héron E, Lozinguez O, Alhenc-Gelas M, Emmerich J, Fiessinger JN. Hypercoagulable states in primary upper-extremity deep vein thrombosis. Arch Intern Med. 2000;160(3):382–6.PubMedCrossRefGoogle Scholar
  14. 14.
    Cassada DC, Lipscomb AL, Stevens SL, Freeman MB, Grandas OH, Goldman MH. The importance of thrombophilia in the treatment of Paget-Schroetter syndrome. Ann Vasc Surg. 2006;20:596–601.PubMedCrossRefGoogle Scholar
  15. 15.
    Schneider DB, Dimuzio PJ, Martin ND, Gordon RL, Wilson MW, Laberge JM, Kerlan RK, Eichler CM, Messina LM. Combination treatment of venous thoracic outlet syndrome: open surgical decompression and intraoperative angioplasty. J Vasc Surg. 2004;40(4):599–603.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2013

Authors and Affiliations

  1. 1.Division of Vascular Surgery, Vascular Surgery DivisionUCLA David Geffen School of MedicineLos AngelesUSA

Personalised recommendations