•In a 1988 report, Adelstein et al discuss prophylaxis against embolic events in the presence of a superior vena cava (SVC) obstruction in the management of 25 patients with malignant superior vena cava syndrome (SVCS).29 •Ten patients were retrospectively reviewed after having been diagnosed clinically without venography and treated without anticoagulation. Five thromboembolic complications occurred, 2 of which proved fatal.•Fifteen patients were prospectively evaluated by means of angiography and then treated with anticoagulants. Angiographic evidence of intraluminal subclavian vein or superior vena cava (SVC) thrombosis was found in 5 of these patients, and no thromboembolic complications occurred.
•Of the 20 patients who were ultimately given anticoagulation therapy, 2 had fatal intracranial hemorrhages.•The authors suggested the need for randomized prospective trials if the role of venography and anticoagulation in this syndrome is to be determined.29
This was malignant SVCS, this was probably more extensive anticoagulation than what we're given, but to me it underlies that anticoagulation needs to be chosen with care and that one of the many big things our docs need to do is to determine what's best in this regard.