title: Permanent pacemaker-related upper extremity deep vein thrombosis: a series of 20 cases.
abstract: BACKGROUND
  Upper extremity deep vein thrombosis (DVT) has become a common occurrence nowadays due to emergence of multiple newer risk factors, such as implantation of permanent pacemaker (PPM) and implantable cardioverter-defibrillators. We are reporting 20 cases of upper extremity DVT related to PPM implantation.
  
  
  RESULTS
  All the patients presented within 6 months, with unilateral upper extremity swelling (90%), pain (45%), erythema (15%), and other less frequent features. Venography established the diagnosis in all the cases. Considering the distribution of possible risk factors of venous thrombosis among our patients, diabetes was the most frequent (present in 45%) followed by smoking (35%), hypertension (30%), obesity with body mass index ≥30 (30%), history of acute myocardial infarction (25%), chronic obstructive pulmonary disease (20%), and history of congestive cardiac failure (15%). Antiplatelets were not found protective against the development of this situation. There was no statistically significant difference in respect to venous access, number of leads, use of previous temporary pacing lead, or poor left ventricular systolic function (ejection fraction ≤40%) among the six patients who presented with complete occlusion of subclavian vein compared to the rest of the 14 patients who had partial occlusion. There were complete resolutions of symptom in 85% of patients after 6 months of anticoagulation therapy in the form of initial intravenous unfractinated heparin followed by oral warfarin.
  
  
  CONCLUSIONS
  Anticoagulation with warfarin for 6 months with initial intravenous unfractionated heparin was a safe and effective mode of therapy in most of the patients with PPM related upper extremity DVT.
authors: Department of Cardiology, Institute of Post Graduate Medical Education & Research and SSKM Hospital, Kolkata, India.
authors: Saroj
authors: S
authors: Mandal
authors: Arindam
authors: A
authors: Pande
authors: Debosmita
authors: D
authors: Mandal
authors: Asutosh
authors: A
authors: Kumar
authors: Achyut
authors: A
authors: Sarkar
authors: Dhiman
authors: D
authors: Kahali
authors: Biswakesh
authors: B
authors: Mazumdar
authors: Manotosh
authors: M
authors: Panja
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D017147:Defibrillators, Implantable / Q000009:adverse effects*; D005260:Female; D006333:Heart Failure / Q000150:complications; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D010138:Pacemaker, Artificial / Q000009:adverse effects*; D011859:Radiography; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D013350:Subclavian Vein / Q000000981:diagnostic imaging; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000188:drug therapy / Q000209:etiology*; D014859:Warfarin / Q000627:therapeutic use
chemical_list: D000925:Anticoagulants; D014859:Warfarin; D006493:Heparin