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Venous Thromboembolism (VTE), Catheter-Related, Clinical Pathway – CICU and CCU

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

 
 
VTE Confirmed
Extremity ultrasound (US) and/or echocardiogram
Consult Cardiac Thrombosis team
 
 
Determine Medical Necessity of Catheter
Cardiac surgeon, CICU attending
 
 
 
 
Catheter Can Be Removed
Catheter Remains in Place
  • Attending team consensus: CICU/CCU, Thrombosis, and Surgical
  • Reviews eligibility for anticoagulation prior to removal
 
 
 
 
Assess Factors for High Bleeding Risk
Attending team consensus: CICU/CCU, Thrombosis, and Surgical
 
 
 
  • Active bleeding
  • Coagulopathy, significant bleeding hx
  • Recent surgery
  • Age < 1 mo
 
Low Bleeding Risk
High Bleeding Risk
 
 
 
 
Risk benefit ratio
favors anticoagulation
Risk outweighs anticoagulation
 
 
 
 

Initiate Enoxaparin

Repeat US at 1 wk

VTE progression: attending team consensus: CICU/CCU, Thrombosis, and Surgical
 
 

Discharge Planning

 
 
 
 
Repeat extremity US, echocardiogram as indicated 6 wks from date of thrombus
 
 
VTE resolved or non-occlusive thrombus
VTE stable with occlusive thrombus
Thrombus progression
 
 
Assess for High Thrombosis Risk
Attending team consensus:
CICU/CCU, Thrombosis, and Surgical
 
 
VTE stable
or resolved
Continue Anticoagulation
Repeat US 12 wks from date of thrombus
 
 
VTE progression
Discuss plan with Cardiac Thrombosis team
  • Presence of central catheter
  • Active infection
  • Strong inherited thrombophilia
  • Persistent pleural infusions
  • Need for multiple catheterizations
 
 
 
 
Low risk
High risk
Discontinue Anticoagulation
Continue Anticoagulation
 
 
 
 
Therapeutic anticoagulation with future central catheters
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