A 30-year-old female presented to her local emergency department with 12 hours of right arm redness and swelling. Her symptoms started acutely while performing her usual daily swim for exercise. She had no other medical history and took no medications other than ibuprofen periodically for musculoskeletal pain. She did not smoke. On exam, the patient had normal vital signs including pulse oximetry. The right arm was noted to be diffusely swollen and ruborous. Motor and sensory function of the hand were intact, and radial and ulnar pulses were palpable. Laboratory studies were unremarkable with the exception of an elevated D-dimer. A musculoskeletal injury was initially suspected, which prompted a computed tomography scan. This study incidentally detected right subclavian deep vein thrombosis (DVT) (Figure 1). The patient was then transferred to a tertiary care center where duplex ultrasonography confirmed the presence of right axillary and subclavian DVT (Figure 2).
Figure 1: CT showing right subclavian DVT (arrows).
Figure 2: Duplex ultrasound demonstrating right upper extremity DVT (arrow).
Which of the following is the best treatment option?