title: Upper-Extremity Deep-Vein Thrombosis: A Retrospective Cohort Evaluation of Thrombotic Risk Factors at a University Teaching Hospital Antithrombosis Clinic.
abstract: Upper-extremity deep-vein thrombosis (UEDVT) causes significant morbidity and mortality and is not well characterized in the existing literature, particularly in underrepresented minorities such as African Americans.
  
  
  
  To describe the characteristics of a cohort of patients with UEDVT seen at an urban academic medical center.
  
  
  
  This was a retrospective cohort study among patients with a confirmed UEDVT at the University of Illinois Hospital and Health Sciences System between 1996 and 2011. Patients were identified by ICD-9 code for UEDVT. Variables collected include thrombotic risk factors and outcomes, including recurrent thrombosis and bleeding.
  
  
  
  We identified 229 patients with UEDVT; 71% were African American, and 11% were diagnosed with sickle cell disease. The average number of UEDVT risk factors was 4.40 ± 1.5, the most common being central venous catheter (CVC) use (178, 78%). In the year following UEDVT, 13% experienced recurrent thrombosis, and 6% experienced major bleeding. Of 181 patients receiving warfarin after an UEDVT, 36% of international normalized ratio (INR) values were therapeutic. Patients with sickle cell disease had a lower proportion of INRs within the target range (25% vs 38%, P < 0.01), and were more likely to be lost to follow-up (67% vs 46%, P = 0.05) and experience a recurrent thrombotic event (29% vs 11%, P = 0.02).
  
  
  
  A CVC is the most common risk factor for UEDVT; however, patients with sickle cell disease demonstrate additional unique demographics and risk factors. Patients included in this underrepresented demographic cohort had a low quality of anticoagulation control, particularly those with sickle cell disease.
authors.affiliation: University of Illinois at Chicago, IL, USA RebeccaHStone@gmail.com.
authors.forename: Rebecca H
authors.initials: RH
authors.lastname: Stone
authors.affiliation: University of Utah, UT, USA.
authors.forename: Adam P
authors.initials: AP
authors.lastname: Bress
authors.affiliation: University of Illinois at Chicago, IL, USA.
authors.forename: Edith A
authors.initials: EA
authors.lastname: Nutescu
authors.affiliation: University of Illinois at Chicago, IL, USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Shapiro
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D062905:Central Venous Catheters / Q000009:adverse effects*; D015331:Cohort Studies; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006784:Hospitals, Teaching; D006785:Hospitals, University; D006801:Humans; D007087:Illinois; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D056824:Upper Extremity Deep Vein Thrombosis / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology*
chemical_list: D000925:Anticoagulants
keywords: anticoagulation; sickle cell disease; upper-extremity deep-vein thrombosis