Central venous catheters and upper-extremity deep-vein thrombosis complicating immune heparin induced thrombocytopenia

Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT Is additionally associated With upper-limb DVT-either with or with-out central venous catheter (CVC) use-is unknown. We therefore studied 260 patients With antibody-positive HIT to determine the influence of CVC use :on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). compared with the control populations, both upper- and lower-extremity DVTs were found to be associated With HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (1 1 4 of 145 [9.7%]) versus none of 115 (0%) patients with but a CVC (P = .00035). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use), and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT. (C) 2003 by The American Society of Hematology.