Hypercoagulability states in upper‐extremity deep venous thrombosis

Leebeek, Frank W.G.; Stadhouders, N.A.M.; Stein, Dorit; Gómez-García, E B; Kappers‐Klunne, M. C.

doi:10.1002/ajh.1070

Cited by 67 publications

(56 citation statements)

References 16 publications

(20 reference statements)

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“…He´ron et al [7] also reported a high prevalence of hypercoagulable status in a population of patients with idiopathic UEDVT compared to those with effort-related UEDVT [42% (13/31) vs. 15% (3/20)]. Leebeek et al [21] recently found thrombophilic defects in 32% of their population with UEDVT and the most frequently found coagulation abnormality was the presence of antiphospholipid antibodies (27%). A recent publication documented the prothrombin G20210A mutation in 12.5% of patients with primary UEDVT and increased thrombotic risk in fertile women using oral contraceptives [22].…”

Section: Discussionmentioning

confidence: 95%

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

et al. 2004

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Primary deep venous thrombosis of the upper extremity (UEDVT) is an unusual disorder. Limited data are available on the contribution of hypercoagulable status in the pathogenesis of this disease. This study aims to report the prevalence of inherited and acquired thrombophilic risk factors (TF) in patients with primary (effort-related and spontaneous) UEDVT. From 1993 to 2002, 31 patients (17 females, median age 38.8 years, range 16-60 years; and 14 males, median age 31.4 years, range 20-56 years) with primary UEDVT (n = 15 effort-related and n = 16 spontaneous) were referred for screening of hypercoagulable status. Nineteen (61.3%) patients had at least one coagulation abnormality. The most common acquired TF were antiphospholipid antibodies (31% lupus anticoagulant and 12.9% anticardiolipin antibodies). Factor V Leiden (12.9%) and prothrombin G20210A mutation (20%) were the most prevalent genetic risk factors. Five patients (16.1%) had high plasma homocysteine levels, and one patient (4.7%) had protein S deficiency. Effortrelated UEDVT was associated with male gender (P = 0.04) and younger age (P = 0.02). There was no significant difference in the prevalence of acquired or inherited TF between patients with effort-related or spontaneous UEDVT. A local anatomic abnormality was detected in seven patients (22.5%), and the prevalence of TF was significantly lower within this group (P = 0.006). The incidence of TF in patients without an anatomic abnormality was 75% (RR 5.25). This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT. Hypercoagulable status may play a significant role in both groups. Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT. Am.

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Section: Discussionmentioning

confidence: 95%

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

et al. 2004

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“…However, one study reported that low antithrombin III levels were associated with a greater risk for thrombosis [42]. Another study found that 32% of patients who had CVC thromboses had diagnoses of a hypercoagulable state; most had elevated anticardiolipin antibody levels, but there was no greater incidence of prothrombin 20210A mutation, Factor V Leiden, protein C deficiency, or protein S deficiency [62]. In a study in children, however, 63% of those with CVC thromboses did have an inherited risk factor, most of whom were compound heterozygotes [36].…”

Section: Patientmentioning

confidence: 99%

Thrombotic Complications of Central Venous Catheters in Cancer Patients

2004

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Central venous catheters (CVCs), such as the tunneled catheters and the totally implanted ports, play a major role in general medicine and oncology. Aside from the complications (pneumothorax, hemorrhage) associated with their initial insertion, all of these CVCs are associated with the long-term risks of infection and thrombosis. Despite routine flushing with heparin or saline, 41% of CVCs result in thrombosis of the blood vessel, and this markedly increases the risk of infection. Only one-third of these clots are symptomatic.Within days of insertion, almost all CVCs are coated with a fibrin sheath, and within 30 days, most CVC-related thrombi arise. Aside from reducing the function of the catheter, these CVC-related thrombi can cause postphlebitic syndrome in 15%-30% of cases and pulmonary embolism in 11% (only half of which are symptomatic).Risk factors for CVC thrombosis include the type of malignancy, type of chemotherapy, type of CVC, and locations of insertion site and catheter tip, but not inherited thrombophilic risk factors. Efforts to reduce CVC thrombosis with systemic prophylactic anticoagulation with lowmolecular-weight heparin have failed. Low-dose warfarin prophylaxis remains controversial; all studies are flawed, with older studies, but not newer ones, showing benefit.Currently, less than 10% of patients with CVCs receive any systemic prophylaxis. Although its general use cannot be recommended, low-dose warfarin may be a low-risk treatment in patients with good nutrition and adequate hepatic function. Clearly, additional studies are required to substantiate the prophylactic use of low-dose warfarin. Newer anticoagulant treatments, such as pentasaccharide and direct thrombin inhibitors, need to be explored to address this major medical problem.

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“…Whether thrombophilia due to deficiencies of the natural anticoagulant proteins antithrombin, protein C, and protein S; gain-of-function mutations in coagulation factor V and the prothrombin gene; or the metabolic abnormality hyperhomocysteinemia is associated with an increased risk of primary upper-extremity DVT remains a matter of debate. 2,[5][6][7][8][9][10][11] In addition, data on oral contraceptives as risk factor for primary upper-extremity DVT are scanty and controversial, 2,5,[7][8][9]11 whereas their role in lower-limb DVT 12 and cerebral vein thrombosis 13 is well established. Moreover, the rate of recurrence of upper-extremity DVT is unknown.…”

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confidence: 99%

Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities

et al. 2004

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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.

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Hypercoagulability states in upper‐extremity deep venous thrombosis

Cited by 67 publications

References 16 publications

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

Thrombotic Complications of Central Venous Catheters in Cancer Patients

Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities

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