title: Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT--either with or without central venous catheter (CVC) use--is unknown. We therefore studied 260 patients with antibody-positive HIT to determine the influence of CVC use on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). Compared with the control populations, both upper- and lower-extremity DVTs were found to be associated with HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (14 of 145 [9.7%]) versus none of 115 (0%) patients without a CVC (P =.000 35). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P =.011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.
authors.affiliation: Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.
authors.forename: Aaron P
authors.initials: AP
authors.lastname: Hong
authors.forename: Deborah J
authors.initials: DJ
authors.lastname: Cook
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Sigouin
authors.forename: Theodore E
authors.initials: TE
authors.lastname: Warkentin
mesh_terms: D001132:Arm / Q000098:blood supply; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000150:complications; D016022:Case-Control Studies; D002405:Catheterization, Central Venous / Q000009:adverse effects; D006493:Heparin / Q000009:adverse effects* / Q000276:immunology; D006801:Humans; D009864:Ontario / Q000453:epidemiology; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D012306:Risk; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D020246:Venous Thrombosis / Q000453:epidemiology / Q000209:etiology*
chemical_list: D006493:Heparin