Preferred Management of Primary Deep Arm Vein Thrombosis.
OBJECTIVE
Given its rarity, the management of primary upper extremity deep vein thrombosis is controversial. Although anticoagulation alone is commonly advocated for its treatment, it is unclear if this will reduce the risk of developing post-thrombotic syndrome (PTS). The aim of this "Evidence Driven" Clinical Scenario is to evaluate whether more aggressive treatments (including catheter directed thrombolysis or surgery) might help reduce the risk of PTS or recurrent venous thromboembolism in patients with primary upper extremity deep vein thrombosis (DVT).


METHODS
An electronic systematic review of Ovid MEDLINE and Embase was conducted. Randomised controlled trials and observational studies were eligible. The primary outcome was PTS.


RESULTS
The initial search identified 146 articles, and 36 more were identified during a secondary search. In total, 25 studies, reporting the outcome of 1271 patients, were included. None of the studies included was a randomised controlled trial and the large majority of studies were retrospective cohorts. The use of anticoagulation alone was associated with a significant risk of PTS. In patients treated with surgery with or without thrombolysis the incidence of PTS was significantly reduced.


CONCLUSIONS
Current evidence, albeit with some methodological limitations, suggests that anticoagulation may not be sufficient to prevent PTS in patients with primary upper extremity DVT and that surgery with or without thrombolysis to repair the anatomical defects is needed.
Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
F J
FJ
Vazquez
Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
P
P
Paulin
Department of Internal Medicine, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
D
D
Poodts
Department of Medicine, University of Ottawa-Ottawa Hospital, Ottawa, Canada; Ottawa Hospital Research Institute, Ottawa, Canada; Department of Internal Medicine, Hospital Privado de Comunidad, Mar del Plata, Argentina. Electronic address: egandara@ohri.ca.
E
E
Gándara
D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use*; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010027:Osteotomy / Q000009:adverse effects; D054070:Postthrombotic Syndrome / Q000209:etiology; D012272:Ribs / Q000601:surgery*; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D014656:Vascular Surgical Procedures / Q000009:adverse effects; D055815:Young Adult
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight
Deep vein thrombosis; Post-thrombotic syndrome; Surgery; Thrombolysis; Upper extremity