Middle age female on long term apixaban for DVT in 2017. She has been stable without evidence of recurrence. She is admitted in 2023 with bacteremia. Has a femoral PICC in place for antibiotic access and a week later develops catheter associated femoral vein DVT. She has had no interruptions in anticoagulation or medication interaction. How do you manage her new PICC associate DVT? If switching to LMWH, would this be a long term strategy or would you consider eventually transitioning back to DOAC? No BMI mid 20s. No malabsorption. No drug interactions. Good adherance
I would presume that the acute illness, sepsis, and introduction of catheter, culminated in the development of the CVC-VTE despite DOAC use, so once all of these additional thrombotic risk factors are resolved, I would go back to DOAC since it had been successful for 5 years prior. If the catheter is still needed and she is still septic, I would temporarily transition to LMWH until resolution and removal of catheter. If she will need IV antibiotics, then keep LMWH for as long as the catheter is in place
