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Bilateral PICC DVT — SCE Medical Oncology MCQ

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HardOncological EmergenciesBilateral PICC DVTSCE Medical Oncology

A 72-year-old woman with cancer develops acute bilateral upper limb DVT from bilateral PICC lines. Both PICCs are needed for ongoing treatment. What anticoagulation approach is recommended?

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Correct answer: B — Anticoagulate therapeutically and retain both functional, required catheters

Cancer-associated catheter DVT is treated with therapeutic anticoagulation while a required, functional, correctly positioned and uninfected catheter may remain. Anticoagulate therapeutically and remove both functional required catheters: routine removal sacrifices needed access when the lines remain functional and uninfected. Anticoagulate prophylactically and retain both functional required catheters: established bilateral catheter thrombosis requires therapeutic rather than prophylactic dosing. Anticoagulate therapeutically and exchange both catheters over guidewires: exchange is unnecessary and may disrupt thrombus when the devices still function. Anticoagulate therapeutically and insert a superior vena-cava filter: caval filters are not routine management of catheter-associated upper-limb DVT.

Reference: International clinical practice guideline for central-venous-catheter thrombosis in cancer (Published February 2013): https://pubmed.ncbi.nlm.nih.gov/23217208/; NICE NG158 venous thromboembolic diseases: recommendations (Updated August 2023): https://www.nice.org.uk/guidance/ng158/chapter/Recommendations