Risk Factors and Management of Patients With Upper Limb Deep Vein Thrombosis

Ellis, Martin; Manor, Yosef; Witz, Misha

doi:10.1378/chest.117.1.43

Cited by 49 publications

(25 citation statements)

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“…Prandoni et al [6] identified a thrombophilic status in seven out of 27 patients (26%) with UEDVT, and Ellis et al [8] demonstrated in a retrospective study the presence of an underlying thrombophilic status in 61% of patients with axillosubclavian thrombosis (11 out of 18 patients). 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)].…”

Section: Discussionmentioning

confidence: 98%

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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: 98%

“…Some of them also incorporated cases with effort-related UEDVT and the prevalence showed range from 8% to 61.1% [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2004

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“…Upper extremity DVT is an uncommon complication, occurring in less than 4% of patients in whom DVT develops [23]. Risk factors for DVT in this location include acquired or inherited hypercoagulable states, anatomic abnormalities causing venous compression, strenuous upper extremity exercise, cancer, and venous catheterization as with pacemakers [2,7,10,15,21,26,40].…”

Section: Discussionmentioning

confidence: 99%

Case Reports: Heritable Thrombophilia Associated with Deep Venous Thrombosis after Shoulder Arthroscopy

Bongiovanni

Ranalletta

Guala

et al. 2009

Clinical Orthopaedics &Amp; Related Research

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“…A falha de enchimento do vaso pelo contraste determina a localização e a extensão do trombo 22 . É facilmente realizada nas situações em que há um cateter de flebotomia como causa dessa afecção, 21,28,29 . Recomenda-se a duração do tratamento inicial com HNF ou HBPM por, pelo menos, 5 dias.…”

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Trombose venosa profunda de membros superiores: estudo coorte retrospectivo de 52 casos

et al. 2005

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275 ResumoObjetivo: Rever os fatores predisponentes e a evolução em série de casos de trombose venosa profunda dos membros superiores de nossa instituição.Métodos: Cinqüenta e dois pacientes consecutivos, com trombose venosa profunda dos membros superiores (29 homens e 23 mulheres), idade média de 52,3 anos, documentados por mapeamento dúplex (71,1%), flebografia (11,1%) ou clinicamente (15,6%), foram incluídos no presente estudo.Resultados: As manifestações clínicas foram: dor no antebraço (24 casos -46,1%), dor no braço (27 casos -51,9%), edema do membro superior (45 casos -86,5%), dor à compressão do membro superior (36 casos -70,2%) e dor à movimentação do mesmo (32 casos -61,7%). Os principais fatores de risco foram: punção ou acesso venoso (20 casos -39,1%) e câncer (16 casos -32,6%). As veias envolvidas foram: umeral (n = 18), axilar (n = 27), subclávia (n = 15) e jugular (n = 11). A embolia pulmonar estava inicialmente presente em quatro casos (7,6%). O tratamento inicial foi feito com heparina não-fracionada intravenosa (64,3%), subcutânea (16,7%), ou heparina de baixo peso molecular (17,1%), seguido de varfarina. Doze pacientes morreram antes da alta, em função de causas não relacionadas à embolia pulmonar. Foram acompanhados os 40 pacientes restantes por período de 3 meses a 10 anos, sendo que dois morreram de causas não relacionadas à embolia pulmonar, um paciente desenvolveu seqüelas pós-trombóticas, como edema residual e limitações aos movimentos, e seis ficaram com discretos sintomas residuais (edema e dor).Conclusões: A trombose venosa profunda dos membros superiores foi mais freqüente em pacientes submetidos a acessos venosos e com neoplasia em atividade. Comparando com dados da literatura, a evolução dos pacientes sob tratamento exclusivo com anticoagulantes foi, no mínimo, similar a outros tratamentos propostos.Palavras-chave: trombose, trombose venosa, extremidade superior, anticoagulantes. AbstractObjective: To review the predisposing factors and the evolution of upper-extremity deep vein thrombosis in a series of cases.Methods: Fifty-two consecutive patients (29 men and 23 women, mean age of 52.3 years) with upper-extremity deep vein thrombosis documented by duplex scan (71.1%), phlebography (11.1%) or clinically (15.6%) were included in the study.Results: Clinical manifestations were: forearm pain (24 cases -46.1%), arm pain (27 cases -51.9%), upper limb edema (45 cases -86.5%), pain to arm compression (36 cases -70.2%) and to arm movement (32 cases -61.7%). Main risk factors were: vein puncture (20 cases -39.1%), and cancer (16 cases -32.6%). Deep vein thrombosis involved humeral (n = 18), axillary (n = 27), subclavian (n = 15) and jugular (n = 11) veins. Pulmonary embolism was initially present in four cases (7.6%). Initial therapy included unfractionated heparin, intravenous (64.3%), subcutaneous (16.7%) or low molecular weight heparin (17.1%) administration, followed by warfarin. Twelve patients died before discharge from the hospital, due to causes not related to pulmonary embolism. T...

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Risk Factors and Management of Patients With Upper Limb Deep Vein Thrombosis

Cited by 49 publications

References 9 publications

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

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

Case Reports: Heritable Thrombophilia Associated with Deep Venous Thrombosis after Shoulder Arthroscopy

Trombose venosa profunda de membros superiores: estudo coorte retrospectivo de 52 casos

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