Published Online
on September 7, 2004

A more recent version of this article appeared on September 21, 2004

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Submitted on February 18, 2004
Revised on June 17, 2004
Accepted on June 18, 2004

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.).

^* To whom correspondence should be addressed. E-mail: sgoldhaber{at}partners.org.

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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