CICU/CCU Pathway for Management of Acute Catheter-Related Venous Thromboembolism (VTE)
Assess if Catheter is Medically Necessary
Notify Cardiac Thrombosis and
Anticoagulation team
Catheter Remains in Place
Repeat US at 1 week to evaluate for extension
Active or High Risk of Bleeding
Repeat US at 1 week if anticoagulation is not initiated
Risk benefit ratio favors anticoagulation
Consider anticoagulation prior to removal for lesions at high risk for embolization with potential hemodynamic compromise
Remove Catheter
Initiate Enoxaparin
Low Risk of Bleeding
Repeat US in 6 weeks
Clot Resolved
Clot Stable
Clot Progression
Continue enoxaparin and Repeat US at 12 weeks

If clot resolved or stable at 12 weeks
Discuss with Cardiac Thrombosis Team
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
Page Cardiac Thrombosis team in Xtend as necessary
Posted: April 2014
Revised: December 2016, January 2019
Authors: L. Raffini, MD; T. Giglia, MD; W. Petrosa, CRNP; R. Keashen, CRNP