The New Treatment Approach to Subclavian Vein Thrombosis

Abstract

The first step in treating Paget–Schroetter syndrome is to initiate anticoagulation in order to prevent further thrombus formation, and propagation into the distal arm as well as to prevent pulmonary thromboembolism. Once the diagnosis is made the patient should be placed on intravenous heparin peripherally using a high intensity regimen: a bolus of 100 u/kg intravenously in a vein of the non-affected arm, followed by continuous intravenous infusion at a rate preferably determined by monitoring the Xa which must reach a level of 0.3–0.7 to be effective. If the medical center is still using the PTT methodology (partial thromboplastin time) this should reach levels between 60 and 80. Before initiating heparin therapy platelet count must be obtained and monitored to detect the development of heparin Induced Thrombocytopenia (HIT). The platelet count can drop drastically and rapidly if patients develop this syndrome. If this complication occurs, heparin must be immediately discontinued and a different anticoagulant employed.