Table 1

Periprocedural Management of Anticoagulation and Antiplatelet Therapy in Patients With IVC Thrombosis

Pre-procedural
 IV UFH (PTT target 2–2.5 times UL) or SC LMWH (stop 8 h before CDT/PMCT)
 Argatroban if HIT (PTT target 2–2.5 times UL)
Intraprocedural
 IV UFH (PTT target 1.5–2 times UL) or bivalirudin
 Argatroban (PTT target 1.5–2 times UL) if or bilvalirudin if HIT
Post-procedural
 IV heparin (start 1 h after sheath removal), or argatroban (PTT target 2–2.5 times UL) if HIT
 Start warfarin or fondaparinux the evening after the procedure
 If PTA/stenting performed: ASA 325 mg and clopidogrel 300–600 mg
Long-term therapy:
 1st Year
 If no PTA/stenting: ASA 81 mg and warfarin daily
 If PTA/stenting: ASA 81 mg, clopidogrel 75 mg daily and warfarin for 1 month, then ASA 81 mg and warfarin daily
 After 1 year
 Repeat venogram
 If no restenosis, continue daily ASA 81 mg indefinitely
 If restenosis/nonocclusive thrombus, continue daily ASA 81 mg and warfarin indefinitely

ASA = aspirin; CDT = catheter-directed thrombolysis; HIT = heparin-induced thrombocytopenia; IV = intravenous; IVC = inferior vena cava; LMWH = low-molecular-weight heparin; NOAC = novel anticoagulant agent; PMCT = pharmacomechanical catheter-directed thrombectomy; PTA = percutaneous transluminal angioplasty; PTT = partial thromboplastin time; SC = subcutaneous; UFH = unfractionated heparin; UL = upper limit of normal.

  • Stop heparin 1 h and LMWH 8 h before CDT/PMCT.

  • Use IV UFH instead if repeat CDT/PMCT sessions are planned or expected.

  • Can substitute warfarin with a NOAC after one month, but higher failure rates have been observed in our experience.