New Information to Identify Those at Risk for Upper Extremity DVT
David W. Hawkins, Pharm.D.
Review: Joffe HV, Kucher N, Tapson VF, Goldhaber SZ; Deep Vein Thrombosis (DVT) FREE Steering Committee. Upper-Extremity Deep Vein Thrombosis: A Prospective Registry of 592 Patients. Circulation. 2004 Sep 21;110(12):1605-11. Epub 2004 Sep 07.
A cross-sectional analysis of a national DVT registry database was conducted to compare the demographics, risk factors, clinical presentation, prophylaxis, and initial management of patients with upper extremity DVT (UEDVT) versus lower extremity DVT (LEDVT). Of the 5388 patients evaluated, 592 (11%) had UEDVT. More than 50% of those patients had received a central venous catheter (CVC) within 30 days of being diagnosed with a DVT and were therefore classified as CVC-associated UEDVT. The remaining patients with UEDVT were classified as non-CVC-associated UEDVT.
The 2 groups of patients with UEDVT were similar in age, gender, ethnicity, and body size. The two groups differed however in that patients with CVC-associated UEDVT were more likely to have undergone major surgery and general anesthesia and to have been immobilized within 30 days of being diagnosed with a DVT.
Compared to patients with LEDVT, the non-CVC-associated UEDVT patients were younger, less often white, leaner, more likely to smoke, less likely to have a history of DVT or PE, more likely to be receiving chemotherapy, and less likely to have undergone major surgery within the preceding 30 days.
The initial treatment strategies did not differ between the 2 UEDVT groups or between patients with UEDVT and LEDVT. However, pharmacological prophylaxis was more often given to the CVC-associated UEDVT patients than to either the non-CVC-associated UEDVT or LEDVT patients. The authors point out that 26% of the UEDVT patients who received pharmacological prophylaxis were given subcutaneous unfractionated heparin, which has not been shown to reduce the risk of UEDVT.
In summary, this paper points out important differences in the epidemiology of UEDVT and LEDVT with which many clinicians may not be familiar. Moreover, the omission of pharmacological prophylaxis in patients at risk for UEDVT and the use of an inappropriate prophylactic regimen require further study and corrective action.