| Title | Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities. | | Author(s) | Martinelli I, Battaglioli T, Bucciarelli P, Passamonti SM, Mannucci PM | | Institution | Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, University of Milano, Italy. martin@policlinico.mi.it | | Source | Circulation 2004 Aug 3; 110(5):566-70. | | MeSH | Activated Protein C Resistance
Adolescent
Adult
Anticoagulants
Antiphospholipid Syndrome
Antithrombin III Deficiency
Arm
Cohort Studies
Contraceptives, Oral, Hormonal
Disease-Free Survival
Factor V
Female
Follow-Up Studies
Humans
Hyperhomocysteinemia
Life Tables
Male
Mass Screening
Middle Aged
Mutation
Prevalence
Protein S Deficiency
Prothrombin
Recurrence
Research Support, Non-U.S. Gov't
Risk Factors
Thrombophilia
Venous Thrombosis
| | Abstract | BACKGROUND: One third of cases of upper-extremity deep vein thrombosis (DVT) are primary, ie, they occur in the absence of central venous catheters or cancer. Risk factors for primary upper-extremity DVT are not well established, and the recurrence rate is unknown.
METHODS AND RESULTS: We studied 115 primary upper-extremity DVT patients and 797 healthy controls for the presence of thrombophilia due to factor V Leiden, prothrombin G20210A, antithrombin, protein C, protein S deficiency, and hyperhomocysteinemia. Transient risk factors for venous thromboembolism were recorded. Recurrent upper-extremity DVT was evaluated prospectively over a median of 5.1 years of follow-up. The adjusted odds ratio for upper-extremity DVT was 6.2 (95% CI 2.5 to 15.7) for factor V Leiden, 5.0 (95% CI 2.0 to 12.2) for prothrombin G20210A, and 4.9 (95% CI 1.1 to 22.0) for the anticoagulant protein deficiencies. Hyperhomocysteinemia and oral contraceptives were not associated with upper-extremity DVT. However, in women with factor V Leiden or prothrombin G20210A who were taking oral contraceptives, the odds ratio for upper-extremity DVT was increased up to 13.6 (95% CI 2.7 to 67.3). The recurrence rate was 4.4% patient-years in patients with thrombophilia and 1.6% patient-years in those without thrombophilia. The hazard ratio for recurrent upper-extremity DVT in patients with thrombophilia compared with those without was 2.7 (95% CI 0.7 to 9.8).
CONCLUSIONS: Inherited thrombophilia is associated with an increased risk of upper-extremity DVT. Oral contraceptives increase the risk only when combined with inherited thrombophilia. The recurrence rate of primary upper-extremity DVT is low but tends to be higher in patients with thrombophilia than in those without. | | Language | eng | | Pub Type(s) | Journal Article
| | PubMed ID | 15262837 |
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