Table 1

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

 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)
 IV UFH (PTT target 1.5–2 times UL) or bivalirudin
 Argatroban (PTT target 1.5–2 times UL) if or bilvalirudin if HIT
 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.