Management

Management is similar to that of a deep venous thrombosis, including: (1)

• anticoagulation to prevent the propagation of thrombus and to encourage clot lysis. Acute treatment with parenteral anticoagulation (low molecular weight heparin, fondaparinux, intravenous/subcutaneous unfractionated heparin) is recommended. Low molecular weight heparin or fondaparinux are preferred. Rivaroxaban and apixaban can also be used.
• anticoagulant therapy is recommended in preference to thrombolysis and should be continued for three months to six months. (2)
• investigation and treatment of predisposing factors

In a few patients, surgical excision of the first rib may be helpful. Investigations are underway to determine if compression therapy may help prevent or treat post-thrombotic syndrome. (3)

Reference

1. Guyatt GH et al; Executive summary: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb;141(2 Suppl):7S-47S.
2. Mustafa J, Asher I, Sthoeger Z; Upper Extremity Deep Vein Thrombosis: Symptoms, Diagnosis, and Treatment. Isr Med Assoc J. 2018 Jan;20(1):53-57.
3. Ramadan SM, Kasfiki EV, Kelly C, Ali I. Primary upper extremity deep vein thrombosis (effort thrombosis). Acute Med. 2021;20(2):151-153