38 year old Hispanic male with ESRD (presumed secondary to HTN and previous IV drug abuse) presented to our outpatient vascular center, 3 weeks post placement of right IJ tunneled catheter after initiation of dialysis. He was complaining of right sided neck swelling and tenderness for 1 week.
An ultrasound revealed a large right IJ thrombus.
Patient has no history of or predisposition to having a hypercoagulable state.
I proceeded, in our outpatient vascular center, to remove the right IJ tunneled catheter and placed a left IJ tunneled catheter. Then I directly admitted the patient to the hospital for initiation of Heparin/Coumadin.
1) Anything wrong with my management?
2) How long would you anticoagulate with Coumadin?
3) If patient was found to have right IJ thrombus incidently and was asymptomatic, would you have done the same thing?