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

Abstract

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.

Editor's Choice – European Society for Vascular Surgery (ESVS) 2021 Clinical Practice Guidelines on the Management of Venous Thrombosis

“…In the Global Anticoagulant Registry in the FIELD e Venous Thromboembolism (GARFIELD-VTE) registry, patients with UEDVT were significantly more likely to have a CVC than those with lower extremity DVT and had a higher rate of active cancer or recent hospitalisation than patients with lower extremity DVT. 283 In a recent metaanalysis, the proportion of PTS was higher in patients with unprovoked UEDVT than secondary, whereas recurrence was higher in secondary UEDVT. 284 3.1.1.1.…”

Direct oral anticoagulants for unusual‐site venous thromboembolism

“…In fact, PE was detected in 3% of UEDVT vs 16% of LEDVT (P < .001), 61 while PTS was described in 15%-25% of cases after UEDVT versus 20%-50% after LEDVT. 62 Mortality was higher in patients with UEDVT versus LEDVT (9.7 vs 6.7 per 100 person-years), 63 which might reflect the higher prevalence and the greater severity of underlying cancer.…”

Upper Extremity Superficial Vein Thromboses Presenting as Acute Neck Pain in a Young and Healthy Male: A Case Report

“…13 The incidence of neck pain caused by a superficial or deep vein thrombosis (DVT) in the upper extremity is less frequent than reported cases of leg pain from a DVT. 3 In light of the subject's history of Lisfranc injury followed by using bilateral axillary crutches for a prolonged period, it is plausible that this subject developed UESVTs, also described as effort thromboses, as a result of his prolonged crutch use. 13 The subject was also questioned further regarding his crutch use and stated that he would often use a single crutch on his injured left-side, further contributing to repetitive stress.…”

“…PICC lines and peripheral venous lines) and in subjects with malignant cancers, infection or inflammatory processes, during pregnancy/post-partum or with haptogastrointestinal pathologies. 3,4 Much less commonly (incidence 1/ 100,000), UESVTs have been reported in male subjects under the age of 30 due to Paget-Schroetter Syndrome (effort thrombosis) or Thoracic Outlet Syndrome (TOS). 4,5 In these rare cases, the presence of repetitive upper extremity movements cause microtrauma to the endothelium creating thromboses.…”