Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis.
J Thromb Haemost. 2016 Feb 11;
Authors: Bleker SM, van Es N, Kleinjan A, Büller HR, Kamphuisen PW, Aggarwal A, Beyer-Westendorf J, Camporese G, Cosmi B, Gary T, Ghirarduzzi A, Kaasjager K, Lerede T, Marschang P, Meijer K, Otten HM, Porreca E, Righini M, Verhamme P, van Wissen S, Nisio MD
BACKGROUND: There is scant information on the optimal management and clinical outcome of deep and superficial vein thrombosis of the upper extremity (UEDVT and UESVT).
OBJECTIVES: To explore treatment strategies and the incidence of recurrent venous thromboembolism (VTE), mortality, postthrombotic symptoms and bleeding in patients with UEDVT and UESVT, and to assess the prognosis of cancer patients with UEDVT.
PATIENTS/METHODS: Follow-up of patients with UEDVT or UESVT, who were enrolled previously in a diagnostic management study.
RESULTS: We followed 102 and 55 patients with UEDVT and UESVT respectively, both for a median of 3.5 years. Anticoagulant treatment was started in 100 patients with UEDVT (98%) and in 40 (73%) with UESVT. Nine patients with UEDVT (9%) developed recurrent VTE, 26 (26%) died, 6 of 72 patients (8%) had moderate postthrombotic symptoms and 5 (5%) experienced major bleeding. One patient with UESVT had a recurrent VTE, 18 (33%) died, none had moderate postthrombotic symptoms and none had major bleeding. Of the cancer patients with UEDVT, 18% had recurrent VTE versus 7.5% in non-cancer patients (adjusted HR 2.2, 95%CI 0.6 to 8.2). The survival rate was 50% in cancer patients with UEDVT versus 60% in those without (adjusted HR 0.8, 95%CI 0.4 to 1.4).
CONCLUSIONS: The risk of recurrent VTE was low in patients with UEDVT, and negligible for UESVT. Mortality was high for both diseases. Postthrombotic symptoms were infrequent and mild. Anticoagulant therapy of UEDVT carried a substantial risk of major bleeding. Cancer patients had a significant risk of recurrent VTE. This article is protected by copyright. All rights reserved.
PMID: 26866515 [PubMed - as supplied by publisher]