Evaluation of Upper Extremity Deep Vein Thrombosis Risk Factors and Management
Background: Upper extremity deep venous thrombosis (UEDVT) incidence and complications are increasing. We evaluated the risk factors and management for patients diagnosed with an UEDVT. Methods: All patients with an UEDVT in 2014 were evaluated for demographics, thrombosis characteristics, risk factors, PADUA risk score, outcomes and management. Results: Ninety UEDVT patients with mean age 57 years, 54.4% maleS, 31% obese (BMI ≥ 30 kg/m2), 26.7% prior VTE, 31.1% readmitted within 30 days. Median length of stay was 14 versus hospital’s 5-7days. 87.8% (n=79) were high risk on admission, 69.6% on anticoagulation when diagnosed. Risk factors: Immobility for 3 days 75 (83.3%), Age <70 years 70 (77.8%), central venous catheters 70 (77.8%), male gender 49 (54.4%), orthopedic trauma / surgery 40 (44.4%), infection/inflammation 33 (36.7%), obesity 28 (31.1%), history of prior VTE 24 (26.7%) and malignancy 16 (17.6%). Hypercoagulability, hormone therapy and pacemaker were noted in <10 % of patients. 87.1% of catheters were PICC lines majority being multi-lumen (98.4%). Indications for catheters were 80.1% medication administration, 7.4% TPN, 3.3% ICU resuscitation, 3.3% dialysis/pheresis. Dedicated IV/PICC team placed 55.8% catheters and 10% had required greater than one attempt. 62.2% UEDVTs were right-sided with, 84.4% proximal and 15.6% distal DVTs. 87% (n=60) catheters were extracted after diagnosis. Therapeutic anticoagulation at discharge was prescribed for only 81.6% of patients with proximal UEDVTs (recommended) and 50% for distal UEDVTs (not recommended). Lower extremity ultrasonography was performed in only 34.4% of patients. 6.7% (n=6) had LEDVT, 3.3% (n=3) PE, and 1.1% (n=1) died. Conclusions: UEDVT most common risk factors (>50%) were decreased mobility, younger age, central venous catheters, males. UEDVT management was suboptimal and warrants standardization.
Heena Sheth, Rahim Remtulla, Abuzar Moradi and Roy Smith