The Risk Factors and Clinical Outcomes of Upper Extremity Deep Vein Thrombosis

Jung-Ah Lee,Brenda K Zierler,R Eugene Zierler

doi:10.1177/1538574411432145

Abstract

The prevalence of upper extremity deep vein thrombosis (UEDVT) has shown a dramatic increase with the use of central venous catheters (CVCs) for patient care. The objective of this study was to identify risk factors and clinical outcomes in patients diagnosed with UEDVT at an academic medical center over a 1-year period. Medical records of 373 consecutive patients who underwent upper extremity venous duplex ultrasound (VDU) examination were retrospectively reviewed. A quarter of the patients screened by VDU (94 of 373) had acute UEDVT; 63% presented with arm swelling or arm pain; 48% had cancer; and 93% had indwelling CVCs. Cancer patients with CVCs were more likely to develop UEDVT (48%). Of the 94 UEDVTs, 16% had concurrent lower extremity DVT. The incidence of objectively confirmed pulmonary embolism (PE) was 9% (8 of 94 patients), and the 1-month mortality rate was 6.4%. The majority of patients (80%) with UEDVT received anticoagulation therapy and 20% were not treated. The most common risk factors for UEDVT were indwelling CVCs and a diagnosis of cancer. The incidence rate of PE and mortality rate from UEDVT were not insignificant at 9% and 6%, respectively. There were no institutional screening protocols for patients at risk of UEDVT associated with CVCs. Future research should focus on risk assessment and management protocols for patients at risk of UEDVT. In addition, a comparison of clinical outcomes associated with the type, size, and duration of catheter placement should be conducted in patients at risk of or diagnosed with UEDVT.

Highlights

Upper extremity deep vein thrombosis (UEDVT) has traditionally been considered a rare condition, partly because of a relatively lower rate of complications when compared to lower extremity deep vein thrombosis (LEDVT).[1,2,3] With an increase in the use of central venous catheters (CVCs) for acute and long-term care, UEDVT has become a more common clinical problem in the last few decades.[4]
The purpose of this study was to identify risk factors associated with acute UEDVT and to describe the clinical outcomes in patients who were objectively diagnosed with acute UEDVT over a 1-year study period
During the 1-year study period, 373 patients at risk of UEDVT with or without typical symptoms and signs were screened by venous duplex ultrasound (VDU)

Summary

Introduction

Upper extremity deep vein thrombosis (UEDVT) has traditionally been considered a rare condition, partly because of a relatively lower rate of complications (eg, pulmonary embolism [PE], postthrombotic syndrome [PTS], and mortality) when compared to lower extremity deep vein thrombosis (LEDVT).[1,2,3] With an increase in the use of central venous catheters (CVCs) for acute and long-term care, UEDVT has become a more common clinical problem in the last few decades.[4]. UEDVT accounts for

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