CICU/CCU Pathway for Management of
Acute Catheter-Related Venous Thromboembolism (VTE)

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Assess if Catheter is Medically Necessary
Catheter Remains in Place
Repeat US at 1 week to evaluate for extension
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Active or High Risk of Bleeding
Repeat US at 1 week if anticoagulation is not initiated
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Risk benefit ratio favors anticoagulation
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Consider anticoagulation prior to removal for lesions at high risk for embolization with potential hemodynamic compromise
Remove Catheter
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Initiate Enoxaparin
Low Risk of Bleeding
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Repeat US in 6 weeks
Clot Resolved
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Clot Stable
Clot Progression
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Continue enoxaparin and Repeat US at 12 weeks

If clot resolved or stable at 12 weeks
Discuss with Cardiac Thrombosis Team
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Low Risk
High Risk
  • Discontinue enoxaparin
  • Discuss use of enoxaparin w/ future indwelling lines
  • Discuss with Cardiac Thrombosis Team
  • Consider chronic anticoagulation
  • Consider enoxaparin while indwelling catheter in place
Posted : April 2014
Authors : L. Raffini, MD, T. Giglia, MD, M. Blumenstein, CRNP, W. Petrosa, CRNP