Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities.
BACKGROUND
One third of cases of upper-extremity deep vein thrombosis (DVT) are primary, ie, they occur in the absence of central venous catheters or cancer. Risk factors for primary upper-extremity DVT are not well established, and the recurrence rate is unknown.


RESULTS
We studied 115 primary upper-extremity DVT patients and 797 healthy controls for the presence of thrombophilia due to factor V Leiden, prothrombin G20210A, antithrombin, protein C, protein S deficiency, and hyperhomocysteinemia. Transient risk factors for venous thromboembolism were recorded. Recurrent upper-extremity DVT was evaluated prospectively over a median of 5.1 years of follow-up. The adjusted odds ratio for upper-extremity DVT was 6.2 (95% CI 2.5 to 15.7) for factor V Leiden, 5.0 (95% CI 2.0 to 12.2) for prothrombin G20210A, and 4.9 (95% CI 1.1 to 22.0) for the anticoagulant protein deficiencies. Hyperhomocysteinemia and oral contraceptives were not associated with upper-extremity DVT. However, in women with factor V Leiden or prothrombin G20210A who were taking oral contraceptives, the odds ratio for upper-extremity DVT was increased up to 13.6 (95% CI 2.7 to 67.3). The recurrence rate was 4.4% patient-years in patients with thrombophilia and 1.6% patient-years in those without thrombophilia. The hazard ratio for recurrent upper-extremity DVT in patients with thrombophilia compared with those without was 2.7 (95% CI 0.7 to 9.8).


CONCLUSIONS
Inherited thrombophilia is associated with an increased risk of upper-extremity DVT. Oral contraceptives increase the risk only when combined with inherited thrombophilia. The recurrence rate of primary upper-extremity DVT is low but tends to be higher in patients with thrombophilia than in those without.
Martinelli
Ida
I
Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, University of Milano, Italy. martin@policlinico.mi.it
Battaglioli
Tullia
T
Bucciarelli
Paolo
P
Passamonti
Serena Maria
SM
Mannucci
Pier Mannuccio
PM
D020016:Activated Protein C Resistance / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D000293:Adolescent; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D016736:Antiphospholipid Syndrome / Q000150:complications / Q000453:epidemiology; D020152:Antithrombin III Deficiency / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D001132:Arm / Q000098:blood supply*; D015331:Cohort Studies; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects; D018572:Disease-Free Survival; D005165:Factor V / Q000235:genetics; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020138:Hyperhomocysteinemia / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D015993:Life Tables; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009154:Mutation; D015995:Prevalence; D018455:Protein S Deficiency / Q000150:complications / Q000453:epidemiology / Q000235:genetics; D011516:Prothrombin / Q000235:genetics; D012008:Recurrence; D012307:Risk Factors; D019851:Thrombophilia / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics; D020246:Venous Thrombosis / Q000453:epidemiology* / Q000209:etiology
D000925:Anticoagulants; D003278:Contraceptives, Oral, Hormonal; C095381:factor V Leiden; D005165:Factor V; D011516:Prothrombin