Upper extremity deep vein thrombosis (UE-DVT) is a common and increasing complication in hospitalized patients. The objective of this study is to determine the prevalence, treatment strategies, complications and outcomes of UE-DVT.
This is a retrospective single-institution study of patients diagnosed with UE-DVT between January 2016 through February 2018 (26 months). Patients 18 years and older, admitted to the hospital who had a positive upper extremity duplex ultrasound for an acute UE-DVT were included in the study. The outcomes were in-hospital mortality, major bleeding, pulmonary embolism and recurrent UE-DVT.
Among 63,045 patients admitted to the hospital, 1,000 (1.6%) patients were diagnosed with UE-DVT. From 3,695 upper-extremity venous duplex ultrasound performed during the study period, almost one third (27.0%) were positive for an acute UE-DVT. The mean age was 55.0±17.2 years, the majority were male (58.3%), Caucasians (49.2%) and overweight (mean BMI 29.4±10.3 Kg/m). The most affected vein was the right internal jugular (54.8%). Most of the patients (96.9%) were on venous thromboembolism (VTE) prophylaxis or anticoagulation at the time of diagnosis. The majority of patients (77.8%) had an intravenous device (IVD) at the time of the diagnosis. Most of the patients (84.4%) were treated with anticoagulation in the hospital but only half (54.5%) were discharged on anticoagulation. In-hospital mortality was 12.1% unrelated to UE-DVT, major bleeding occurred in 47.6% of the patients during hospitalization (fatal bleeding=1%), pulmonary embolism was diagnosed in 4.8% of patients, and 0.7% were fatal. Recurrent UE-DVT occurred in 6.1% of the patients. In a multivariable analysis, the risk of death was increased by older age, cancer, admission to an intensive care unit, concomitant lower extremity DVT (LE-DVT), and bleeding prior to the UE-DVT diagnosis, while the presence of an IVD increased the risk of PE. The risk of recurrent UE-DVT was increased by the presence of an IVD. The risk of major bleeding was increased by the presence of an IVD, in female patients and those with a concomitant LE-DVT.
Upper-extremity DVT is a common complication in hospitalized patients (1.6%). Consequent acute PE and recurrent DVT remain important complications, as does bleeding. It is unclear if standard thromboprophylaxis effectively protects against UE-DVT. More studies dedicated to UE-DVT are required to provide appropriate guidance on prophylaxis and treatment.

Copyright © 2021. Published by Elsevier Inc.