Deep Venous Thrombosis Of The Upper Extremity With Special Emphasis On Studies Of Coagulation And Fibrinolysis

Abstract

Deep venous thrombosis (DVT) in the upper extremity is rare as compared to DVT in the leg. It has been claimed to be caused often by trauma to the axillary vein or unaccustomed heavy work (“effort”) with the arms. Our series of 53 patients shows the same peak incidence with regard to age (mean age 32.4+11.7) as earlier reported. However, a preceding trauma or “effort” was only found in 12 % in this particular series of patients. Other predisposing factors such as cancer (2/53), thoracic outlet syndrome (3/53) etc were rare. The coagulation studies included the following analyses: VIII:C, VIIIR:Ag, AT III and inhibitors of the plasminogen activators (PA inhibitor). The vessel wall fibrinolysis was studied in two different ways: 1) the capacity to release fibrinolytic activators from the vessel wall (venous occlusion test according to Robertson et al (1972), and 2) the fibrinolytic activity within the vessel wall (histochemical technique according to Pandolfi 1972). An impaired vessel wall fibrinolysis was found in 49 % of our patients which is a slightly lower figure than the 70 % incidence of this abnormality found in patients with spontaneous DVT in the lower extremity. The higher incidence of females as compared to earlier reports could not be explained by the use of contraceptive pills since the frequency of women on the pill seemed to be about the same as in the Swedish population as a whole.All patients had normal values of factor VIII, AT III and PA inhibitors.It is concluded that an impaired vessel wall fibrinolysis may be an important contributing factor also for DVT in the arm. Fibrinolytic studies may therefore be important in evaluating these patients.