This handout is for upper-extremity dvt (subclavian / axillary / brachial). Your care team identified this based on: unilateral arm swelling, pain, warmth, prominent collateral veins → suggests uedvt.
Other reasons your team may use this plan: young athlete with repetitive arm overhead activity (rowing, swimming, weightlifting) → paget-schroetter (primary uedvt); cvc, picc, port, or pacemaker lead present → secondary uedvt (most common cause).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| apixaban | 10 mg BID × 7 d → 5 mg BID | PO | BID × ≥3 months (or while catheter in place) | AMPLIFY PMID 23808982 — UEDVT extrapolated; ACCP 2021 supports DOAC for UEDVT |
| rivaroxaban | 15 mg BID × 21 d → 20 mg daily | PO | BID then daily × ≥3 months | EINSTEIN-DVT subgroup; ACCP 2021 |
| edoxaban | 60 mg daily after 5 d LMWH lead-in | PO | daily × ≥3 months | Hokusai-VTE PMID 23991958 — UEDVT included in trial |
| enoxaparin | 1 mg/kg SC BID | SC | BID | ASH 2018 in pregnancy; CARAVAGGIO PMID 32223112 alt in cancer-UEDVT |
| alteplase | 0.5-1 mg/h via catheter for 12-24 h | IV_catheter | continuous infusion | CDT for primary (Paget-Schroetter) within 14 d restores venous patency; Engelberger Thromb Res 2014; Joffe ASH 2017 |
Plan: Upper-extremity DVT anticoagulation — DOAC-first per ACCP 2021
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Primary: surgical (thoracic surgery / vascular) consult for first-rib resection within 4-6 weeks. Secondary: AC continued while catheter in place (or 3 months if removed)
Guideline: ACCP/CHEST 2021 Antithrombotic + ASH 2020 VTE Treatment + Joffe ASH 2017 UEDVT review