Treatment of venous thrombosis at unusual sites

The literature is filled with randomized controlled trial data to guide most steps in managing patients with deep venous thrombosis of the extremities or pulmonary embolism. Venous thrombosis, however, is not limited to these locations and may involve the cerebral venous sinuses, renal veins, splanchnic veins, and ovarian veins. The causes of these thrombi are often unique to the venous segments involved and typically stem from pathologies of the organs supplied by these veins. Very little randomized controlled trial data exist to guide therapy for these atypical venous thrombi. Treatment should focus on correcting the underlying disease and relieving venous congestion of the involved organ while preserving organ functionality. Although natural history data are limited, recurrence rates for these atypical venous thrombi appear to be relatively low. Indefinite secondary anticoagulant prophylaxis is therefore primarily dictated by the congenital or acquired pathology precipitating the event.