The condition is not as rare as is usually thought, or as benign.
Historically, upper-extremity deep venous thrombosis (DVT) has been thought of as rare and benign. Utilizing a multinational registry of consecutive patients with objectively confirmed acute DVT or pulmonary embolism (PE), researchers assessed the clinical outcomes of patients who presented with upper extremity DVT.
Of the 11,000 patients enrolled in the registry, 512 (4.4%) had upper-extremity DVT, and virtually all received anticoagulants. Patients with upper-extremity DVT were more likely to have cancer (38% vs. 20%) and less likely to present with an overt PE (9% vs. 29%) than were those with lower-extremity DVT; 45% of upper-extremity DVT patients had catheter-related DVT. At 3 months, the incidence of major bleeding, recurrent DVT, or recurrent PE (composite endpoint) was similar among patients with upper- or lower-extremity DVT. However, among patients with upper-extremity DVT, those with cancer had the highest incidence of the composite endpoint (9.7%), whereas those without cancer and without catheters had the lowest incidence (0.5%).
Comment: In this prospective study, researchers found that upper-extremity DVT is neither rare nor benign. Patients with upper-extremity DVT and cancer are at high risk for adverse events, whereas those without cancer and without catheters are at low risk. These results support a guideline from the American College of Chest Physicians that advises similar treatment for upper-arm DVT and lower-extremity DVT in all patients except those at lowest risk.
Published in Journal Watch General Medicine February 14, 2008
Muñoz FJ et al. Clinical outcome of patients with upper-extremity deep vein thrombosis: Results from the RIETE Registry. Chest 2008 Jan; 133:143.