Upper extremity deep vein thrombosis: a retrospective cohort evaluation at a university teaching hospital antithrombosis clinic

Purpose: The purpose of this study is to identify risk factors associated with upper-extremity deep venous thrombosis (UEDVT) and to determine appropriateness of current prophylaxis strategies utilized. 

Methods: A retrospective cohort evaluation of patients with a confirmed UEDVT managed at the University of Illinois at Chicago (UIC) Antithrombosis Clinic between May 1, 2007 and October 1, 2011. Patients were identified by an ICD9 code for UEDVT (451.89, 453.82) in the electronic medical record. The primary outcome variables included were: patient demographics,  past medical history, and details specific to UEDVT prophylaxis, location, symptoms, diagnosis, and treatment. A standardized data collection sheet was utilized and descriptive statistics were peformed with Excel software.

Results: A total of 232 out of 332 patients met criteria for study inclusion. The average patient age was 49.7 + 15.2 years, the average BMI was 28.8 + 8.0 kg/m², and 165 (71.1%) patients were African American. The average number of UEDVT risk factors was 5.1 + 1.8, and the most common risk factor was central venous catheter use in 175 (75.4%) patients. Of 109 patients with UEDVT diagnosed in the inpatient setting, 72 (66.1%) received documented DVT prophylaxis. Of the 182 patients receiving a long term vitamin k antagonist with 4 or more INR results, 36.6% of INR values were within theraputic range. Of the 153 patients followed 3 months or longer after their UEDVT, 40 (26.1%) experienced a recurrent thrombotic event. During acute and long term treatment, 19 (8.2%) patients experienced a documented major bleeding event.  

Conclusion: Patients with UEDVT had multiple risk factors for thrombosis, did not always receive DVT prophylaxis, and had a low quality of control of anticoagulation. Patients with UEDVT had a significant rate of documented recurrent thrombosis and bleeding events.