Recurrent thrombosis and survival after a first venous thrombosis of the upper extremity.
BACKGROUND
Little is known about the consequences of a first venous thrombosis in the upper extremity. We studied the incidence of, survival, and risk factors for recurrence in a follow-up study.


RESULTS
We followed up 224 patients 18 to 70 years of age after a first venous thrombosis of the arm. Information was collected through anticoagulation clinics, the national death registry, discharge letters, and questionnaires. The median follow-up was 3 years, during which time 30 patients experienced a recurrent event, yielding an incidence rate of 43.2 per 1000 person-years. Survival was reduced: 55 of 224 patients died, which was 5.4-fold higher than age- and sex-adjusted population rates (standardized mortality ratio, 5.4; 95% CI, 4.2 to 7.0). The risk of recurrence was 2-fold higher in women than in men (hazard ratio, 1.8; 95% CI, 0.9 to 3.9). A central venous catheter at the time of first thrombosis was associated with a reduced risk of recurrence. A body mass index > or =25 kg/m(2) and a first nonsubclavian thrombosis appeared to increase the risk of a recurrent event. Prothrombotic mutation carriers did not appear to have an increased recurrence risk.


CONCLUSIONS
The risk of recurrence was high, with women, patients with body mass index > or =25 kg/m(2), and patients with a first nonsubclavian vein thrombosis having a higher risk of recurrence. Patients with a first venous thrombosis of the arm have a poor vital prognosis.
Flinterman
L E
LE
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
van Hylckama Vlieg
A
A
Rosendaal
F R
FR
Doggen
C J M
CJ
D000293:Adolescent; D000328:Adult; D000368:Aged; D001367:Axillary Vein; D001780:Blood Coagulation Tests; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007601:Jugular Veins; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality; D012008:Recurrence; D012307:Risk Factors; D017678:Sex Distribution; D013350:Subclavian Vein; D016019:Survival Analysis; D034941:Upper Extremity / Q000098:blood supply*; D014680:Veins; D020246:Venous Thrombosis / Q000188:drug therapy / Q000401:mortality*; D014812:Vitamin K / Q000037:antagonists & inhibitors
D014812:Vitamin K