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Upper-extremity deep vein thrombosis: a prospective registry of 592 patients.

Abstract

BACKGROUND

Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer.

METHODS AND RESULTS

To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non-CVC-associated UEDVT patients were younger (59.2+/-18.2 versus 64.2+/-16.9 years old; P<0.0001), less often white (65% versus 73%; P<0.01), leaner (body mass index [BMI] 26.8+/-7.1 versus 28.5+/-7.3 kg/m2; P<0.001), and more likely to smoke (19% versus 13%; P=0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of <67 years, a BMI of <25 kg/m2, and hospitalization were the independent predictors of non-CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis.

CONCLUSIONS

UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.

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  • Authors+Show Affiliations

    ,

    Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass 02115, USA.

    , , ,

    Source

    Circulation 110:12 2004 Sep 21 pg 1605-11

    MeSH

    Adolescent
    Adult
    Aged
    Aged, 80 and over
    Anticoagulants
    Arm
    Case Management
    Catheterization, Central Venous
    Continental Population Groups
    Cross-Sectional Studies
    Female
    Humans
    Immobilization
    Inpatients
    Leg
    Male
    Middle Aged
    Neoplasms
    Obesity
    Organ Specificity
    Postoperative Complications
    Prospective Studies
    Pulmonary Embolism
    Registries
    Risk Factors
    Smoking
    Thinness
    Thrombolytic Therapy
    Thrombophlebitis
    Ultrasonography
    United States

    Pub Type(s)

    Comparative Study
    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    15353493

    Citation

    Joffe, Hylton V., et al. "Upper-extremity Deep Vein Thrombosis: a Prospective Registry of 592 Patients." Circulation, vol. 110, no. 12, 2004, pp. 1605-11.
    Joffe HV, Kucher N, Tapson VF, et al. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation. 2004;110(12):1605-11.
    Joffe, H. V., Kucher, N., Tapson, V. F., & Goldhaber, S. Z. (2004). Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation, 110(12), pp. 1605-11.
    Joffe HV, et al. Upper-extremity Deep Vein Thrombosis: a Prospective Registry of 592 Patients. Circulation. 2004 Sep 21;110(12):1605-11. PubMed PMID: 15353493.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. AU - Joffe,Hylton V, AU - Kucher,Nils, AU - Tapson,Victor F, AU - Goldhaber,Samuel Z, AU - ,, Y1 - 2004/09/07/ PY - 2004/9/9/pubmed PY - 2005/6/9/medline PY - 2004/9/9/entrez SP - 1605 EP - 11 JF - Circulation JO - Circulation VL - 110 IS - 12 N2 - BACKGROUND: Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. METHODS AND RESULTS: To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)-associated UEDVT, 268 (5%) patients with non-CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non-CVC-associated UEDVT patients were younger (59.2+/-18.2 versus 64.2+/-16.9 years old; P<0.0001), less often white (65% versus 73%; P<0.01), leaner (body mass index [BMI] 26.8+/-7.1 versus 28.5+/-7.3 kg/m2; P<0.001), and more likely to smoke (19% versus 13%; P=0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of <67 years, a BMI of <25 kg/m2, and hospitalization were the independent predictors of non-CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis. CONCLUSIONS: UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts. SN - 1524-4539 UR - https://www.unboundmedicine.com/medline/citation/15353493/Upper_extremity_deep_vein_thrombosis:_a_prospective_registry_of_592_patients_ L2 - http://www.ahajournals.org/doi/full/10.1161/01.CIR.0000142289.94369.D7?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -