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(Circulation. 2004;110:1605-1611.)
© 2004 American Heart Association, Inc.

Epidemiology

Upper-Extremity Deep Vein Thrombosis

A Prospective Registry of 592 Patients

Hylton V. Joffe, MD; Nils Kucher, MD; Victor F. Tapson, MD; Samuel Z. Goldhaber, MD, for the Deep Vein Thrombosis (DVT) FREE Steering Committee

From the Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (H.V.J., N.K., S.Z.G.); and the Department of Medicine, Duke University Medical Center, Durham, NC (V.F.T.).

Correspondence to Samuel Z. Goldhaber, MD, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St, Boston, MA 02115. E-mail sgoldhaber{at}partners.org

Received February 18, 2004; de novo received April 4, 2004; revision received June 17, 2004; accepted June 18, 2004.

Background— Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer.

Methods and Results— To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter (CVC)–associated UEDVT, 268 (5%) patients with non–CVC-associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter 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<0.001), 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 regression 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/m², and hospitalization were the independent predictors of non–CVC-associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation 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.

Key Words: thrombosis • risk factors • prevention • anticoagulants

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