Thrombolysis for acute upper extremity deep vein thrombosis

Feinberg, Joshua; Jakobsen, Janus Christian

doi:10.1002/14651858.cd012175

Cited by 10 publications

(13 citation statements)

References 37 publications

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“…Thrombolysis is suggested as a potential treatment option for acute UEDVT of the axillary of more proximal veins. There are no RCTs on the use of thrombolysis in patients with UEDVT [ 61 ]. Three observational studies compared thrombolytic therapy and anticoagulation with anticoagulation alone in patients with primary and secondary UEDVT.…”

Section: Treatmentmentioning

confidence: 99%

Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

Bosch

Nisio

Büller

et al. 2020

JCM

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Upper extremity deep vein thrombosis (UEDVT) accounts for 5% of all deep vein thromboses (DVTs). UEDVT may be complicated by post thrombotic syndrome and pulmonary embolism, and early recognition and prompt start of anticoagulant treatment are key. Primary UEDVT, also known as Paget-von Schrötter syndrome, is associated with repeated or sudden physical activity of the upper arm and venous outflow obstruction due to anatomical variations. Secondary UEDVT is often associated with malignancy or use of intravenous devices, such as central venous catheters or pacemaker leads. Although the diagnosis and treatment of UEDVT have many similarities with DVT of the lower extremities, knowledge of specific aspects regarding UEDVT is important to guide optimal management. In this review, we will discuss the epidemiology, diagnosis, and treatment of UEDVT based on the current literature.

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Section: Treatmentmentioning

confidence: 99%

Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

Bosch

Nisio

Büller

et al. 2020

JCM

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“…Patients with recent (< 1 week) extensive, typically iliofemoral, DVT or with phlegmasia cerulea dolens and at low bleeding risk were poorly represented in this trial and may yet benefit from catheter‐directed thrombolysis (evidence level C) . In contrast to leg DVT, there have been no randomised trials of thrombolysis for treatment of arm DVT …”

Section: Managementmentioning

confidence: 99%

Deep vein thrombosis: update on diagnosis and management

Krüger

Eikelboom

Douketis

et al. 2019

Medical Journal of Australia

109

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Summary Diagnosis of deep vein thrombosis (DVT) requires a multifaceted approach that includes clinical assessment, evaluation of pre‐test probability, and objective diagnostic testing. Common symptoms and signs of DVT are pain, swelling, erythema and dilated veins in the affected limb. The pre‐test probability of DVT can be assessed using a clinical decision rule that stratifies DVT into “unlikely” or “likely”. If DVT is “unlikely”, refer for D‐dimer test. If the D‐dimer level is normal, DVT can be excluded; if the D‐dimer level is increased, refer for compression ultrasound. If DVT is “likely”, refer for compression ultrasound. When DVT is confirmed, anticoagulation is indicated to control symptoms, prevent progression and reduce the risk of post‐thrombotic syndrome and pulmonary embolism. Anticoagulation may consist of a parenteral anticoagulant overlapped by warfarin or followed by a direct oral anticoagulant (DOAC) (dabigatran or edoxaban), or of a DOAC (apixaban or rivaroxaban) without initial parenteral therapy. DOACs are the preferred treatment for DVT because they are at least as effective, safer and more convenient than warfarin. DOACs may require dose reduction or avoidance in patients with renal dysfunction, and should be avoided in pregnancy. Recent evidence shows that DVT in patients with cancer may be treated with edoxaban (after discontinuation of 5 days of initial heparin or low molecular weight heparin [LMWH]) or rivaroxaban if patients prefer not to have daily injections of LMWH, but the risk of gastrointestinal bleeding is higher with DOACs than with LMWH in patients with gastrointestinal cancer.

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“…Upper extremity deep vein thrombosis (UEDVT), arising in the brachial, axillary, or subclavian veins, accounts for up to one-tenth of the total burden of DVT. [1][2][3][4][5][6][7][8][9][10] UEDVT may be unprovoked or caused by a number of provoking factors, most commonly central venous catheter (CVC) placement, 6,[11][12][13][14][15][16][17] cancer, 5,6,13 surgery, 2,8,18 limb immobilization due to plaster cast, 2,8 heritable and acquired thrombophilias, 2 or the thoracic outlet syndrome (TOS)-that is, compression and occlusion of the subclavian vein between the clavicle and first rib. 2,19,20 Most of the information on UEDVT derives from small case series that have produced somewhat inconsistent findings.…”

Section: Introductionmentioning

confidence: 99%

Upper Extremity DVT versus Lower Extremity DVT: Perspectives from the GARFIELD-VTE Registry

et al. 2019

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Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT (LEDVT) and consequently less well characterized. This study compared clinical characteristics and 1-year outcomes between 438 UEDVT patients and 7,602 LEDVT patients recruited in the GARFIELD-VTE registry. UEDVT patients were significantly more likely to have a central venous catheter than those with LEDVT (11.5% vs. 0.5%; p < 0.0001), and had a higher rate of active cancer (16.2%) or recent hospitalization (19.4%) compared with LEDVT patients (8.7% and 11.2%, respectively). Nearly all patients with UEDVT and LEDVT were initiated on anticoagulant therapy, which was a direct oral anticoagulant in one-third individuals in both groups. At 3, 6, and 12 months, the proportion of UEDVT and LEDVT patients who were receiving anticoagulant therapy was 82.6 and 87.4%, 66.0 and 72.6%, and 45.7 and 54.6%, respectively. In the UEDVT and LEDVT groups, VTE recurrence rate was 4.0 (95% confidence interval [CI], 2.4–6.7) and 5.5 (95% CI, 4.9–6.1) per 100 person-years, respectively; major bleed was noted in 1.3 (95% CI, 0.6–3.2) and 1.6 (95% CI, 1.3–1.9) per 100 person-years and all-cause mortality in 9.7 (95% CI, 7.1–13.4) and 6.7 (95% CI, 6.1–7.3) per 100 person-years, respectively. Hence, risk of recurrence was similar in the two groups whereas all-cause mortality was significantly higher in the UEDVT group than the LEDVT group (p = 0.0338). This latter finding was likely due to the high prevalence of cancer in the UEDVT group.

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Thrombolysis for acute upper extremity deep vein thrombosis

Cited by 10 publications

References 37 publications

Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

Diagnostic and Therapeutic Management of Upper Extremity Deep Vein Thrombosis

Deep vein thrombosis: update on diagnosis and management

Upper Extremity DVT versus Lower Extremity DVT: Perspectives from the GARFIELD-VTE Registry

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