Upper-extremity deep vein thrombosis - A prospective registry of 592 patients

Background - Upper-extremity deep vein thrombosis (UEDVT) occurs spontaneously or sometimes develops as a complication of pacemaker use, long-term use of a central venous catheter (CVC), or cancer. Methods and Results - To improve our understanding of UEDVT, we compared the demographics, symptoms, risk factors, prophylaxis, and initial management of 324 (6%) patients with central venous catheter ( CVC) - associated UEDVT, 268 (5%) patients with non - CVC- associated UEDVT, and 4796 (89%) patients with lower-extremity DVT from a prospective US multicenter DVT registry. The non - CVC- associated UEDVT patients were younger (59.2 +/- 18.2 versus 64.2 +/- 16.9 years old; P < 0.0001), less often white (65% versus 73%; P < 0.01), leaner ( body mass index [BMI] 26.8 +/- 7.1 versus 28.5 +/- 7.3 kg/m(2); P < 0.001), and more likely to smoke ( 19% versus 13%; P = 0.02) than the lower-extremity DVT patients. By way of propensity analysis and multivariable logistic regression analysis, we determined that an indwelling CVC was the strongest independent predictor of UEDVT ( odds ratio [ OR], 7.3; 95% confidence interval [CI], 5.8 to 9.2). An age of < 67 years, a BMI of < 25 kg/m(2), and hospitalization were the independent predictors of non - CVC- associated UEDVT. Most (68%) UEDVT patients were evaluated while they were inpatients. Only 20% of the 378 UEDVT patients who did not have an obvious contraindication to anticoagulation received prophylaxis at the time of diagnosis. Conclusions - UEDVT risk factors differ from the conventional risk factors for lower-extremity DVT. Our findings identify deficiencies in our current understanding and the prophylaxis of UEDVT and generate hypotheses for future research efforts.