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Thromb Haemost 2019; 119(08): 1365-1372
DOI: 10.1055/s-0039-1688828
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Upper Extremity DVT versus Lower Extremity DVT: Perspectives from the GARFIELD-VTE Registry

Walter Ageno
1   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Sylvia Haas
2   Department of Medicine, Technical University of Munich, Munich, Germany
,
Jeffrey I. Weitz
3   Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
,
Samuel Z. Goldhaber
4   Harvard Medical School, Harvard University, Boston, Massachusetts, United States
,
Alexander G. G. Turpie
5   Department of Medicine, McMaster University, Hamilton, Ontario, Canada
,
Shinya Goto
6   Department of Medicine (Cardiology), Tokai University School of Medicine, Tokyo, Japan
,
Pantep Angchaisuksiri
7   Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Joern Dalsgaard Nielsen
8   Copenhagen University Hospital, Copenhagen, Denmark
,
Gloria Kayani
9   Thrombosis Research Institute, London, United Kingdom
,
Alfredo E. Farjat
9   Thrombosis Research Institute, London, United Kingdom
,
Audrey Zaghdoun
9   Thrombosis Research Institute, London, United Kingdom
,
Sebastian Schellong
10   Medical Division 2, Municipal Hospital Dresden-Friedrichstadt, Dresden, Germany
,
Henri Bounameaux
11   Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
,
Lorenzo G. Mantovani
12   Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
,
Paolo Prandoni
13   Arianna Foundation on Anticoagulation, Bologna, Italy
,
Harald Darius
14   Vivantes Neukoelln Medical Center, Berlin, Germany
,
Ajay K. Kakkar
15   Thrombosis Research Institute and University College London, London, United Kingdom
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Publikationsverlauf

28. Januar 2019

29. März 2019

Publikationsdatum:
10. Juni 2019 (online)

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Abstract

Upper extremity deep vein thrombosis (UEDVT) is less common than lower extremity DVT (LEDVT) and consequently less well characterized. This study compared clinical characteristics and 1-year outcomes between 438 UEDVT patients and 7,602 LEDVT patients recruited in the GARFIELD-VTE registry. UEDVT patients were significantly more likely to have a central venous catheter than those with LEDVT (11.5% vs. 0.5%; p < 0.0001), and had a higher rate of active cancer (16.2%) or recent hospitalization (19.4%) compared with LEDVT patients (8.7% and 11.2%, respectively). Nearly all patients with UEDVT and LEDVT were initiated on anticoagulant therapy, which was a direct oral anticoagulant in one-third individuals in both groups. At 3, 6, and 12 months, the proportion of UEDVT and LEDVT patients who were receiving anticoagulant therapy was 82.6 and 87.4%, 66.0 and 72.6%, and 45.7 and 54.6%, respectively. In the UEDVT and LEDVT groups, VTE recurrence rate was 4.0 (95% confidence interval [CI], 2.4–6.7) and 5.5 (95% CI, 4.9–6.1) per 100 person-years, respectively; major bleed was noted in 1.3 (95% CI, 0.6–3.2) and 1.6 (95% CI, 1.3–1.9) per 100 person-years and all-cause mortality in 9.7 (95% CI, 7.1–13.4) and 6.7 (95% CI, 6.1–7.3) per 100 person-years, respectively. Hence, risk of recurrence was similar in the two groups whereas all-cause mortality was significantly higher in the UEDVT group than the LEDVT group (p = 0.0338). This latter finding was likely due to the high prevalence of cancer in the UEDVT group.

Keywords

upper extremity deep vein thrombosis - lower extremity deep vein thrombosis - direct oral anticoagulant - venous thromboembolism - GARFIELD-VTE registry

Note

The GARFIELD-VTE Registry is an independent academic research initiative sponsored by the Thrombosis Research Institute (London, United Kingdom) and supported by an unrestricted research grant from Bayer Pharma AG (Berlin, Germany).