Response to Letter Regarding Article, “Physician Alerts to Prevent Symptomatic Venous Thromboembolism in Hospitalized Patients”
We thank Dr Spyropoulos for his comments on our article.1 Upper-extremity deep vein thrombosis (UEDVT) has become more common over the past several decades.2 This phenomenon is due to the increasing use of indwelling central venous catheters, pacemakers, and defibrillators. We advocate studying UEDVT in venous thromboprophylaxis trials.
In a study of 483 outpatients presenting with objectively confirmed acute DVT, 69 had UEDVT.3 More than half of these patients with UEDVT had a history of recent prior hospitalization. An analysis of a subset of these patients who had been hospitalized within the 3 months prior to UEDVT diagnosis demonstrated that fewer than half received any thromboprophylaxis. Importantly, rates of mortality, recurrent venous thromboembolism, and major bleeding at 30 days, 6 months, and 1 year were comparable between UEDVT patients and those with lower extremity DVT. In the Registro Informatizado de la Enfermedad Tromboembólica (RIETE) Registry, investigators observed similar findings with no significant difference in 3-month outcome for bleeding or recurrent venous thromboembolism when comparing 512 UEDVT patients with 11 052 patients who had lower extremity DVT.4
For too long, UEDVT has been treated like a neglected orphan within the field of venous thromboembolism. We encourage investigators to include UEDVT patients when they plan and execute their clinical trials.
Dr Pendergast has received grants from and consulted for sanofi-aventis and been on the speakers’ bureau of sanofi-aventis, Pfizer, and Novartis. Dr McClaren has received research grants from sanofi-aventis and Bristol-Myers Squibb. Dr Patton has received honoraria from St. Joseph Mercy Health System. Dr Dabbagh has received research grants from Bristol-Myers Squibb and Pfizer and honoraria from the Missouri Society of Respiratory Therapists. Dr Goldhaber has received research grants from and consulted for or been on advisory boards for sanofi-aventis, Eisai, and Boehringer Ingelheim. He has also consulted for Bristol-Myers Squibb. The remaining authors report no conflicts.
Piazza G, Rosenbaum EJ, Pendergast W, Jacobson JO, Pendleton RC, McLaren GD, Elliott CG, Stevens SM, Patton WF, Dabbagh O, Paterno MD, Catapane E, Li Z, Goldhaber SZ. Physician alerts to prevent symptomatic venous thromboembolism in hospitalized patients. Circulation. 2009; 119: 2196–2201.
Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis. Circulation. 2002; 106: 1874–1880.