Examples of therapeutic decision making for first-episode venous thrombosis in infants, children, and adolescents
Nonocclusive DVT, no ongoing trigger (eg, catheter is removed) or prothrombotic conditions → anticoagulation → |
| Thrombus resolved within 6 wk |
| Newborn: anticoagulation for 10 d or until clot resolves |
| Infant, child, adolescent: anticoagulation for 6 wk to 3 mo |
| Thrombus not resolved within 6 wk → anticoagulation until clot resolves, 3-12 mo* |
| Occlusive DVT, or nonocclusive central thrombus, symptoms less than 14 d → anticoagulation or systemic low-dose TPA → anticoagulation until clot resolves, 3 to 12 mo* |
| Occlusive superior or inferior vena cava or iliac, or hemodynamically significant cardiac clot, symptoms present no more than 14 d → systemic thrombolysis → if not resolved in 24-48 h → interventional radiology for catheter-directed thrombectomy/thrombolysis if clot persists, anticoagulation for 12 mo* |
| Occlusive superior or inferior vena cava or iliofemoral or cardiac, symptoms present more than 14 days → intervention radiology for catheter-directed thrombectomy/thrombolysis if clot persists, anticoagulation for 12 mo* |
Nonocclusive DVT, no ongoing trigger (eg, catheter is removed) or prothrombotic conditions → anticoagulation → |
| Thrombus resolved within 6 wk |
| Newborn: anticoagulation for 10 d or until clot resolves |
| Infant, child, adolescent: anticoagulation for 6 wk to 3 mo |
| Thrombus not resolved within 6 wk → anticoagulation until clot resolves, 3-12 mo* |
| Occlusive DVT, or nonocclusive central thrombus, symptoms less than 14 d → anticoagulation or systemic low-dose TPA → anticoagulation until clot resolves, 3 to 12 mo* |
| Occlusive superior or inferior vena cava or iliac, or hemodynamically significant cardiac clot, symptoms present no more than 14 d → systemic thrombolysis → if not resolved in 24-48 h → interventional radiology for catheter-directed thrombectomy/thrombolysis if clot persists, anticoagulation for 12 mo* |
| Occlusive superior or inferior vena cava or iliofemoral or cardiac, symptoms present more than 14 days → intervention radiology for catheter-directed thrombectomy/thrombolysis if clot persists, anticoagulation for 12 mo* |
Indefinite long-term anticoagulation for all persistent lupus anticoagulant or 3 trait or greater thrombophilia