The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study

Prandoni, Paolo; Bernardi, Enrico; Marchiori, Antonio; Lensing, Anthonie W. A.; Prins, Martin H.; Villalta, Sabina; Bagatella, Paola; Sartor, Donatella; Piccioli, Andrea; Simioni, Paolo; Pagnan, Antonio; Girolami, Antonio

doi:10.1136/bmj.38167.684444.3a

Cited by 148 publications

(141 citation statements)

References 5 publications

(8 reference statements)

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“…Small cohort studies involving patients with Paget-Schroetter syndrome given anticoagulation alone showed that post-thrombotic syndrome occurred in 27%-46% of patients. 3,7,8 As a result of the disappointing results achieved with anticoagulation alone, the use of thrombolysis has become more widespread in the hope that early restoration of venous patency will reduce the incidence of post-thrombotic syndrome. Thrombolysis is performed in experienced centres in patients with a low risk of bleeding and severe symptoms that are consist ent with Paget-Schroetter syndrome.…”

Section: Managementmentioning

confidence: 99%

Spontaneous deep vein thrombosis in the upper extremity of a 45-year-old woman

Stein

McLeod

Devine

2014

CMAJ

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A 45-year-old woman presented to her family doctor following a three-day history of acute-onset, progressive swelling and sensation of heaviness in her left upper extremity. In addition, she described pleuritic chest pain and dyspnea on exertion. Five days before presentation, she had been lifting heavy furniture and boxes and had performed her regular exercise routine that involved lifting 10-and 15-pound weights overhead. She had no history of thrombosis and no family history of clotting disorders. Her medical history included Hashimoto thyroiditis and remote iron deficiency anemia secondary to menorrhagia. Cancer screening had yielded normal results on a Papanicolaou test and a colonoscopy performed three years earlier. She had no recent immobilization, surgery or long-distance travel and was not taking supplemental estrogen. The patient was referred to the emergency department for evaluation of suspected deep vein thrombosis (DVT) in her left upper extremity and pulmonary embolus.In the emergency department, she had a regular heart rate of 96 beats/min and an oxygen saturation of 95% on room air. Her temperature and blood pressure were within normal limits. There was obvious swelling of the entire left upper extremity, dilated subcutaneous collateral veins over the anterior shoulder, and mild cyanosis in the hand and fingers. Neurologic and arterial examinations of the upper extremities yielded normal findings. Venous duplex ultrasonography showed an occlusive thrombus in the left subclavian and axillary veins. Computed tomography pulmonary angiography showed pulmonary emboli in the bilateral subsegmental arteries. The patient was admitted, and treatment with low-molecular-weight hep arin was started.The following morning, the patient underwent peripheral venography (Figure 1) with catheter-directed thrombolysis using a tissue plasminogen activator. She subsequently received ongoing anticoagulation with intravenous unfractionated heparin. A follow-up venogram 24 hours after the thrombolysis showed resolution of the clot; however, severe stenosis of the left subclavian vein was noted. Angioplasty of the stenotic area was only partially successful, leaving residual stenosis of the subclavian vein in the neutral position, with dynamic occlusion on abduction of the left upper extremity (Figure 2). Two days later, the patient was discharged home and prescribed low-molecularweight heparin.Two months after discharge, the patient underwent an uncomplicated transaxillary resection of the left first rib to relieve compression of the subclavian vein. Venography performed one month later showed resolution of the subclavian vein stenosis and of the dynamic occlusion (Figure 3). In discussion with her treating physician, the patient elected to complete a further three months of anticoagulation with therapeutic doses of low-molecular-weight heparin instead of transitioning to oral anticoagulation following her surgery. She experienced good functional recovery of her left upper extremity, with no recurrence of DVT.

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Section: Managementmentioning

confidence: 99%

Spontaneous deep vein thrombosis in the upper extremity of a 45-year-old woman

Stein

McLeod

Devine

2014

CMAJ

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“…However, the total mortality of patients with upper extremity and lower extremity thrombosis appears to be similar and is mainly related to the underlying disease (Spencer et al, 2007;Munoz et al, 2008). Contrary to common believe, post-thrombotic syndrome is not a rare complication in deep arm vein thrombosis and may lead to functional disability and significant impaired quality of life in these patients (Prandoni et al, 2004;Kahn et al, 2005;Vik et al, 2009). Two modified versions of a validated score system for post-thrombotic syndrome in lower extremity thrombosis (Prandoni et al, 1997b) have been adapted to arm vein thrombosis (Table 4).…”

Section: Natural History and Complicationsmentioning

confidence: 89%

Deep Vein Thrombosis of the Arms

Marschang¹

2012

Deep Vein Thrombosis

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“…2 The incidence of postthrombotic syndrome remains problematic even years after thrombosis. 16,22 The young woman in this case continued to experience symptoms of postthrombotic syndrome (at last contact, 1.5 years after onset of symptoms), including minor discomfort and edema in her right upper extremity.…”

Section: Discussionmentioning

confidence: 99%

“…Postthrombotic syndrome is a common consequence associated with chronic venous hypertension, with incidence estimates of 27.3% to 49.0%. 16,22,23 Symptoms may range from mild discomfort and edema to significant pain and dysfunction, although severe complaints are rare. 2 The incidence of postthrombotic syndrome remains problematic even years after thrombosis.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis of a Rare Source of Upper Extremity Symptoms in a Healthy Female After Weight Lifting

Hegedus

Cooper²,

Cook³

2006

J Orthop Sports Phys Ther

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3Study Design: Resident's case problem. Background: The popularity of weight training has increased dramatically during the past 20 years. With the increase in popularity of weight training, the rate of injury has also increased dramatically. The types of injuries range from benign to life threatening. Diagnosis: The patient was a 21-year-old woman originally referred for pelvic pain who presented with new complaints of right upper extremity swelling, discomfort, and cyanosis after recently beginning a comprehensive weight-lifting program. Additional signs, including paresthesias, decreased pulses, and venous distension, warranted a timely referral by the physical therapist back to the referring physician. Discussion: The primary injury in this case report was hypothesized to have been induced by the recent start of a weight-lifting program, with no other significant contributing risk factors. A comprehensive examination by the physical therapist revealed clinical signs of an upper extremity deep vein thrombosis, leading to a same-day referral back to the referring physician. Further research, resulting in a clinical decision rule for upper extremity deep vein thrombosis or estimates of diagnostic accuracy of clinical signs and symptoms, would improve the diagnostic process.

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The long term clinical course of acute deep vein thrombosis of the arm: prospective cohort study

Cited by 148 publications

References 5 publications

Spontaneous deep vein thrombosis in the upper extremity of a 45-year-old woman

Spontaneous deep vein thrombosis in the upper extremity of a 45-year-old woman

Deep Vein Thrombosis of the Arms

Diagnosis of a Rare Source of Upper Extremity Symptoms in a Healthy Female After Weight Lifting

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