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(Circulation. 2008;118:1366-1372.)
© 2008 American Heart Association, Inc.

Vascular Medicine

Recurrent Thrombosis and Survival After a First Venous Thrombosis of the Upper Extremity

L.E. Flinterman, MSc; A. van Hylckama Vlieg, PhD; F.R. Rosendaal, MD, PhD; C.J.M. Doggen, PhD

From the Department of Clinical Epidemiology (L.E.F., A.v.H.V., F.R.R., C.J.M.D.), Department of Thrombosis and Haemostasis (F.R.R.), and Einthoven Laboratory for Experimental Vascular Medicine (F.R.R.), Leiden University Medical Center, Leiden, the Netherlands.

Correspondence to F.R. Rosendaal, Department of Clinical Epidemiology, C-7P, PO Box 9600, 2300 RC Leiden, Netherlands. E-mail F.R.Rosendaal{at}lumc.nl

Received November 5, 2007; accepted July 23, 2008.

Background— Little is known about the consequences of a first venous thrombosis in the upper extremity. We studied the incidence of, survival, and risk factors for recurrence in a follow-up study.

Methods and Results— We followed up 224 patients 18 to 70 years of age after a first venous thrombosis of the arm. Information was collected through anticoagulation clinics, the national death registry, discharge letters, and questionnaires. The median follow-up was 3 years, during which time 30 patients experienced a recurrent event, yielding an incidence rate of 43.2 per 1000 person-years. Survival was reduced: 55 of 224 patients died, which was 5.4-fold higher than age- and sex-adjusted population rates (standardized mortality ratio, 5.4; 95% CI, 4.2 to 7.0). The risk of recurrence was 2-fold higher in women than in men (hazard ratio, 1.8; 95% CI, 0.9 to 3.9). A central venous catheter at the time of first thrombosis was associated with a reduced risk of recurrence. A body mass index 25 kg/m² and a first nonsubclavian thrombosis appeared to increase the risk of a recurrent event. Prothrombotic mutation carriers did not appear to have an increased recurrence risk.

Conclusions— The risk of recurrence was high, with women, patients with body mass index 25 kg/m², and patients with a first nonsubclavian vein thrombosis having a higher risk of recurrence. Patients with a first venous thrombosis of the arm have a poor vital prognosis.

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