摘要
Background Upper extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long term use of a c entral venous catheter (CVC), or cancer. Methods and Results To improve our und erstanding of UEDVT, we compared the demographics, symptoms, risk factors, proph ylaxis, and initial management of 324 (6%) patients with central venous cathete r (CVC) associated UEDVT, 268 (5%) patients with non CVC associated UEDVT, a nd 4796 (89%) patients with lower extremity DVT from a prospective US multicen ter DVT registry. The non CVC associated UEDVT patients were younger (59.2±18 .2 versus 64.2±16.9 years old; P< 0.0001), less often white (65%versus 73%; P < 0.01), leaner (body mass index [BMI] 26.8±7.1 versus 28.5±7.3 kg/m2; P< 0. 00 1), and more likely to smoke (19%versus 13%; P=0.02) than the lower extremity DVT patients. By way of propensity analysis and multivariable logistic regressi on analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95%confidence interval [CI], 5.8 to 9 .2). An age of< 67 years, a BMI of< 25 kg/m 2, and hospitalization were the inde pendent predictors of non CVC associated UEDVT. Most(68%) UEDVT patients were evaluated while they were inpatients. Only 20%of the 378 UEDVT patients who di d not have an obvious contraindication to anticoag ulation received prophylaxis at the time of diagnosis. Conclusions UEDVT risk factors differ from the conventional risk factors for lower extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.
Background Upper extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long term use of a c entral venous catheter (CVC), or cancer. Methods and Results To improve our und erstanding of UEDVT, we compared the demographics, symptoms, risk factors, proph ylaxis, and initial management of 324 (6%) patients with central venous cathete r (CVC) associated UEDVT, 268 (5%) patients with non CVC associated UEDVT, a nd 4796 (89%) patients with lower extremity DVT from a prospective US multicen ter DVT registry. The non CVC associated UEDVT patients were younger (59.2±18 .2 versus 64.2±16.9 years old; P< 0.0001), less often white (65%versus 73%; P < 0.01), leaner (body mass index [BMI] 26.8±7.1 versus 28.5±7.3 kg/m2; P< 0. 00 1), and more likely to smoke (19%versus 13%; P=0.02) than the lower extremity DVT patients. By way of propensity analysis and multivariable logistic regressi on analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT (odds ratio [OR], 7.3; 95%confidence interval [CI], 5.8 to 9 .2). An age of< 67 years, a BMI of< 25 kg/m 2, and hospitalization were the inde pendent predictors of non CVC associated UEDVT. Most(68%) UEDVT patients were evaluated while they were inpatients. Only 20%of the 378 UEDVT patients who di d not have an obvious contraindication to anticoag ulation received prophylaxis at the time of diagnosis. Conclusions UEDVT risk factors differ from the conventional risk factors for lower extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.
