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

Assess if catheter is medically necessary
Notify Cardiac Thrombosis Team
Catheter Can Be Removed
Catheter Remains in Place
Consider anticoagulation before removal for VTE at high-risk for embolization
Low Risk of Bleeding
Active or High Risk of Bleeding
Risk benefit ratio
favors anticoagulation
Risk outweighs anticoagulation
  • Repeat US at 1 wk
  • Consult Cardiac Thrombosis Team if VTE progression
Initiate Enoxaparin
Consider stopping chronic anti-platelet therapy
Repeat US in 6 wks
VTE Resolved
VTE Stable
VTE Progression
  • Assess ongoing risk factors for thrombosis
    • Presence of central catheter
    • Active infection
    • Draining chest tubes
    • Strong inherited thrombophilia
Continue enoxaparin
Repeat US in 6 wks
  • VTE stable or resolved
  • Contact Cardiac Thrombosis Team if VTE progression
Discuss with Cardiac Thrombosis Team
Low Risk
High Risk
  • Discontinue enoxaparin
  • Discuss use of enoxaparin with future indwelling lines
  • Discuss with Cardiac Thrombosis Team
  • Consider chronic anticoagulation
  • Consider enoxaparin while indwelling catheter in place
Therapeutic anticoagulation with
future mid and central line
Posted: April 2014
Revised: April 2024
Editors: Clinical Pathways Team