Rock Climbing Leads to. . .

A previously healthy 38-year-old male smoker presents to the emergency room with a 48-hour history of acute onset of right upper extremity swelling, erythema, and discomfort. On further questioning, he had gone rock climbing as he does on many nights, with symptom onset about 12 hours later. Due to symptoms persisting for an additional 36 hours with increasing right arm discomfort, he presented to the emergency department. He denies any prior history of blood clots or family history of clotting disorders. Physical examination is remarkable for right upper extremity non-pitting edema with overlying erythema from the shoulder to the wrist and mild distention of the superficial arm veins. His right radial pulse is normal with full range of motion of the right upper extremity. A duplex is performed which is notable for thrombosis of the right brachial, axillary, and subclavian veins.

What is the most appropriate management for this patient?

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