Upper extremity deep vein thrombosis
- 1 July 1999
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Pulmonary Medicine
- Vol. 5 (4), 222
- https://doi.org/10.1097/00063198-199907000-00008
Abstract
Upper extremity deep-vein thrombosis has recently been recognized as being a more common and less benign disease than previously reported. It arises generally in the presence of recognizable risk factors, such as central venous catheters and cancer. However, as many as 20% of patients present with apparently spontaneous episodes. The prevalence of inherited coagulation defects in patients with this disease ranges from 10% to 26%. The clinical picture of upper extremity DVT is characterized by pain, edema, and functional impairment, although it may be completely asymptomatic. Because the prevalence of this thrombotic disease is less than 50% among symptomatic subjects, objective diagnosis is mandatory prior to instituting an anticoagulant treatment. When available, compression ultrasonography (alone or associated with Doppler or color Doppler facilities) should be the preferred initial diagnostic test. However, contrast venography may be necessary before anticoagulants are withheld because of negative findings on compression ultrasonography. Pulmonary embolism complicates upper extremity deep-vein thrombosis in up to 36% of patients and may even be the presenting manifestation of this disorder. Its long-term clinical course is complicated by recurrent thromboembolism and postthrombotic sequelae. Among the therapeutic options advocated for the therapy of upper extremity deep-vein thrombosis, unfractionated or low molecular weight heparin followed by at least 3 months of oral anticoagulants should be regarded as the treatment of choice. Thrombolysis and surgical procedures may be indicated in selected cases. The prevention of this disease requires the institution of appropriate pharmacologic measures (ie, low-dose unfractionated or low molecular weight heparin or low-dose warfarin) whenever an indwelling central venous catheter is indicated. This review suggests that upper extremity deep-vein thrombosis is at least as serious a disease entity as deep-vein thrombosis of the lower extremities.Keywords
This publication has 28 references indexed in Scilit:
- Central Vein Catheter-Related Thrombosis in Intensive Care PatientsChest, 1998
- Upper extremity deep venous thrombosis and its impact on morbidity and mortality rates in a hospital-based populationJournal of Vascular Surgery, 1997
- Upper extremity versus lower extremity deep venous thrombosisThe American Journal of Surgery, 1997
- Pulmonary embolism in deep venous thrombosis of the upper extremity: more often in catheter-related thrombosisThe Netherlands Journal of Medicine, 1997
- CENTRAL VENOUS THROMBOSIS: AN EARLY AND FREQUENT COMPLICATION IN CANCER PATIENTS BEARING LONG-TERM SILASTIC CATHETER. A PROSPECTIVE STUDYThrombosis Research, 1997
- Upper-extremity deep vein thrombosis. Risk factors, diagnosis, and complicationsArchives of Internal Medicine, 1997
- Axillary and subclavian venous thrombosis. Prognosis and treatmentArchives of Internal Medicine, 1991
- Subclavian vein thrombosis in patients treated with infusion chemotherapy for advanced malignancyCancer, 1983
- Thrombosis of Axillary and Subclavian VeinsArchives of Surgery, 1967
- Venous obstruction in the upper extremityBritish Journal of Surgery, 1948