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Progressive Supranuclear Palsy—An Unusual Cause of Memory Loss and Falling

strate greater mortality despite high risk of pulmonary embolism in individuals with non-lower limb DVT, the recommended treatment is anticoagulation with fondaparinux or LMWH. Data regarding unfavorable outcomes associated with SVT are much less conclusive, and management of SVT is not as standardized as for DVT. International scientific societies recommend anticoagulation for ultrasounddefined lower limb SVT, favoring the use of prophylactic doses of fondaparinux (2.5 mg/d) over a prophylactic dose of LMWH in individuals with a lower limb SVT at least 5 cm in diameter. To our knowledge, no recommendations have been made about upper extremities SVT. The publication of the Comparison of Arixtra in Lower Limb Superficial Vein Thrombosis with Placebo trial validated anticoagulation with fondaparinux for individuals with acute, symptomatic lower limb SVT. The prescription of LMWH for SVT is also common, but use of extended prophylactic doses and exact dosage are debated. To the best of the knowledge of the authors of the current letter, no data ever demonstrated efficacy of anticoagulation for SVT in frail multimorbid elderly adults, and data on upper limbs thrombosis are even less complete. In the man described herein, it is likely that LMWH therapy resulted in subcutaneous bleeding, which formed an abscess. Frail multimorbid elderly adults are susceptible to drug adverse effects and complications, and expected benefit and potential harm should always be considered when determining treatment. In young, fit individuals with SVT, anticoagulation can accelerate pain relief and mobility, improving quality of life. In frail bedridden individuals, concerns about mobility are negligible, and pain can be successfully treated using better-tolerated drugs. In such an individual, treatment of suspected upper limb SVT with full-dose LMWH is unlikely to be beneficial and could substantially increase the risk of bleeding events. Knowledge of guidelines is an essential step in daily clinical practice, but physicians should always keep in mind that most of these guidelines are based on studies that enrolled younger, healthier participants than those found in realworld clinical practice. Moreover, a careful analysis of the balance between benefit and harm should always be made for frail, vulnerable individuals, who are highly susceptible to serious adverse events.