The risk factors and clinical outcomes of upper extremity deep vein thrombosis.
The prevalence of upper extremity deep vein thrombosis (UEDVT) has shown a dramatic increase with the use of central venous catheters (CVCs) for patient care. The objective of this study was to identify risk factors and clinical outcomes in patients diagnosed with UEDVT at an academic medical center over a 1-year period. Medical records of 373 consecutive patients who underwent upper extremity venous duplex ultrasound (VDU) examination were retrospectively reviewed. A quarter of the patients screened by VDU (94 of 373) had acute UEDVT; 63% presented with arm swelling or arm pain; 48% had cancer; and 93% had indwelling CVCs. Cancer patients with CVCs were more likely to develop UEDVT (48%). Of the 94 UEDVTs, 16% had concurrent lower extremity DVT. The incidence of objectively confirmed pulmonary embolism (PE) was 9% (8 of 94 patients), and the 1-month mortality rate was 6.4%. The majority of patients (80%) with UEDVT received anticoagulation therapy and 20% were not treated. The most common risk factors for UEDVT were indwelling CVCs and a diagnosis of cancer. The incidence rate of PE and mortality rate from UEDVT were not insignificant at 9% and 6%, respectively. There were no institutional screening protocols for patients at risk of UEDVT associated with CVCs. Future research should focus on risk assessment and management protocols for patients at risk of UEDVT. In addition, a comparison of clinical outcomes associated with the type, size, and duration of catheter placement should be conducted in patients at risk of or diagnosed with UEDVT.
Program in Nursing Science, University of California Irvine, Irvine, California 92697, USA. jungahl@uci.edu
Jung-Ah
JA
Lee
Brenda K
BK
Zierler
R Eugene
RE
Zierler
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000295:instrumentation; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology*; D011655:Pulmonary Embolism / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000453:epidemiology*; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
D000925:Anticoagulants