Post-Thrombotic Syndrome, Functional Disability and Quality of Life after Upper Extremity Deep Venous Thrombosis in Adults.

Abstract

Background: The post-thrombotic syndrome (PTS) after upper extremity deep venous thrombosis (UEDVT) has not been well characterized.Objectives: To describe and quantify residual symptoms, functional disability and quality of life associated with post-thrombotic syndrome after UEDVT in adults.Methods: Twenty-four patients with objectively diagnosed UEDVT (bilateral in 1 patient) at least 6 months previously were recruited from two thrombosis clinics in Canada (Montreal and Ottawa). Data were collected by interview and chart review on demographic characteristics, DVT risk factors and affected venous segments. The Villalta PTS scale, modified for the upper extremity, was used to diagnose PTS and to quantify its severity (score >4=PTS; score >14=severe PTS). Patients completed questionnaires on type and severity of symptoms, degree of functional disability (DASH questionnaire) (higher scores=greater disability), and generic (SF-36) and disease-specific (VEINES-QOL) quality of life (lower scores=worse QOL). Results of these measures were compared in patients with and without PTS.Results: The mean age of study patients was 51 years and 54% were female. The average time since diagnosis of UEDVT was 13 months and median duration of warfarin treatment was 5 months. At the time of assessment, daily ipsilateral arm or hand swelling was reported by 52% of patients and daily ipsilateral arm pain by 20% of study patients, compared with 0% and 0%, respectively, in the contralateral arm. PTS was present in 11/25 (44%) limbs (11/24 patients). One patient had severe PTS. Patients with PTS had significantly higher mean DASH scores than those without PTS (23.3 vs. 3.9, p= 0.009) and poorer quality of life than those without PTS (mean VEINES-QOL score 45.6 vs. 53.6; p=0.001; mean SF-36 Physical Component Score (PCS) 40.8 vs. 50.2; p= 0.12). Although the overall frequency of PTS did not differ according to whether the initial UEDVT was in the dominant arm, PTS scores were higher and quality of life was poorer when PTS involved the dominant arm.Conclusion: PTS occurs frequently after UEDVT at a rate that is similar to that of lower limb DVT. PTS of the upper extremity is associated with significant functional disability and has a measurable, adverse impact on quality of life. Patients with dominant arm PTS appear to fare worse than those with non-dominant arm PTS. Larger, prospective studies to identify prognostic factors that lead to PTS after UEDVT are warranted.