Optimal Therapy for Effort Thrombosis of the Axillary Vein

Evidence-Based Management Approach

• The American College of Chest Physicians recommends acute treatment with parenteral anticoagulation (LMWH, fondaparinux, IV UFH, or SC UFH) as the first step for all patients with axillary vein thrombosis, with LMWH or fondaparinux preferred over IV UFH and SC UFH for initial anticoagulation 1
• The American College of Chest Physicians suggests anticoagulant therapy alone over thrombolysis for most cases of UEDVT (Grade 2C), but certain patient factors, such as those who place high value on prevention of post-thrombotic syndrome, may favor thrombolysis 1, 2
• Patients who may benefit most from thrombolysis include younger, active individuals who can access catheter-directed thrombolysis 1, 2
• For UEDVT not associated with a central venous catheter or cancer, a minimum of 3 months of anticoagulation is recommended, with the same intensity and duration of anticoagulation recommended for patients who undergo thrombolysis as for those who do not 1, 3