admittomedicine

unusual site thrombosis

2 min read

red flag: the workup

Thrombosis in “weird” places (Brain, Gut) is the primary indication for a full thrombophilia workup (unlike standard PE/DVT).

  1. Myeloproliferative Neoplasms (JAK2 V617F): Positive in ~30% of splanchnic clots even with normal CBC.
  2. Paroxysmal Nocturnal Haemoglobinuria (PNH).
  3. Antiphospholipid Syndrome.
  4. Hereditary Thrombophilia: (Protein C/S, Antithrombin, FVL) – Specifically indicated for CVST and Splanchnic (non-cirrhotic).

cerebral venous sinus thrombosis (cvst)

  • S/Sx: Headache (mass effect/thunderclap), papilloedema, seizure, focal deficits.
  • Dx: CT Venogram or MR Venogram.
  • Rx:
    • Acute: LMWH (or UFH).
    • Chronic: Warfarin or DOAC.

    • exam pearl

    • Anticoagulation is indicated even if there is venous haemorrhage on imaging (bleeds are due to venous congestion; treating the clot fixes the bleed).

splanchnic vein thrombosis

  • Sites: Portal, Mesenteric, Splenic, Hepatic (Budd-Chiari Syndrome).
  • Management:
    • Acute: Immediate anticoagulation (LMWH DOAC/Warfarin).
    • Chronic (Cavernoma): Controversial. Expert opinion. Treat if progression or high risk of extension.
    • Budd-Chiari: High mortality.
      • Rx: Indefinite anticoagulation.
      • Intervention: Thrombolysis or TIPS often required to decompress liver.

upper extremity dvt (uedvt)

anatomy trap

  • Deep: Subclavian, Axillary, Brachial, Internal Jugular. (Treat as DVT)
  • Superficial: Cephalic, Basilic. (See superficial vein thrombosis)
  • Etiology & Management:
    1. Catheter-Associated (Deep Veins - e.g. PICC/CVC):
      • Anticoagulation: Yes (3 months).
      • The Line: Do NOT remove routinely if functional/needed. Treat with line in situ.
      • Contrast with Superficial IV (Cephalic): Remove line, NSAIDs only.
    2. Paget-Schroetter Syndrome (“Effort Thrombosis”):
      • Young athletes, thoracic outlet obstruction.
      • Rx: Anticoagulation + Vascular Surgery referral.

related pages: Deep Vein Thrombosis, Hereditary Thrombophilia

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