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Clinical Session
From: The Hospitalist, May 2010
“Controversies in Anticoagulation and Thrombosis”
by Richard Quinn
ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.
Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.
Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.
Some of Dr. Barlow’s key take-home points:
- Treat UEDVT seriously;
- Understand there is a higher rate of PE than previously thought;
- Insert central-vein catheters judiciously, and keep them in if you still need them;
- Manage the duration of therapy parallel to that of lower extremity DVT; and
- Routine thrombolytics use isn’t indicated at this time. HM10
current issue
January 2012
The Hospitalist newsmagazine reports on issues and trends in hospital medicine. The Hospitalist reaches more than 25,000 hospitalists, physician assistants, nurse practitioners, residents, and medical administrators interested in the practice and business of hospital medicine.
Copyright © 2000–2012 by John Wiley & Sons, Inc. or related companies. All rights reserved.
ISSN: 1553-085X
