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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
› Author Affiliations
Further Information

Publication History

28 January 2019

29 March 2019

Publication Date:
10 June 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).


 

  • References

  • 1 Bernardi E, Pesavento R, Prandoni P. Upper extremity deep venous thrombosis. Semin Thromb Hemost 2006; 32 (07) 729-736
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Flinterman LE, Van Der Meer FJM, Rosendaal FR, Doggen CJM. Current perspective of venous thrombosis in the upper extremity. J Thromb Haemost 2008; 6 (08) 1262-1266
    CrossrefPubMedGoogle Scholar
  • 3 Lechner D, Wiener C, Weltermann A, Eischer L, Eichinger S, Kyrle PA. Comparison between idiopathic deep vein thrombosis of the upper and lower extremity regarding risk factors and recurrence. J Thromb Haemost 2008; 6 (08) 1269-1274
    CrossrefPubMedGoogle Scholar
  • 4 Muñoz FJ, Mismetti P, Poggio R. , et al; RIETE Investigators. Clinical outcome of patients with upper-extremity deep vein thrombosis: results from the RIETE Registry. Chest 2008; 133 (01) 143-148
    CrossrefPubMedGoogle Scholar
  • 5 Isma N, Svensson PJ, Gottsäter A, Lindblad B. Upper extremity deep venous thrombosis in the population-based Malmö thrombophilia study (MATS). Epidemiology, risk factors, recurrence risk, and mortality. Thromb Res 2010; 125 (06) e335-e338
    CrossrefPubMedGoogle Scholar
  • 6 Spiezia L, Simioni P. Upper extremity deep vein thrombosis. Intern Emerg Med 2010; 5 (02) 103-109
    CrossrefPubMedGoogle Scholar
  • 7 Bleker SM, van Es N, Kleinjan A. , et al. Current management strategies and long-term clinical outcomes of upper extremity venous thrombosis. J Thromb Haemost 2016; 14 (05) 973-981
    CrossrefPubMedGoogle Scholar
  • 8 Montiel FS, Ghazvinian R, Gottsäter A, Elf J. Treatment with direct oral anticoagulants in patients with upper extremity deep vein thrombosis. Thromb J 2017; 15: 26
    CrossrefPubMedGoogle Scholar
  • 9 Cote LP, Greenberg S, Caprini JA. , et al; RIETE Investigators. Comparisons between upper and lower extremity deep vein thrombosis: a review of the RIETE Registry. Clin Appl Thromb Hemost 2017; 23 (07) 748-754
    CrossrefPubMedGoogle Scholar
  • 10 Feinberg J, Nielsen EE, Jakobsen JC. Thrombolysis for acute upper extremity deep vein thrombosis. Cochrane Database Syst Rev 2017; 12: CD012175
    CrossrefPubMedGoogle Scholar
  • 11 Vik A, Holme PA, Singh K. , et al. Catheter-directed thrombolysis for treatment of deep venous thrombosis in the upper extremities. Cardiovasc Intervent Radiol 2009; 32 (05) 980-987
    CrossrefPubMedGoogle Scholar
  • 12 Lobo BL, Vaidean G, Broyles J, Reaves AB, Shorr RI. Risk of venous thromboembolism in hospitalized patients with peripherally inserted central catheters. J Hosp Med 2009; 4 (07) 417-422
    CrossrefPubMedGoogle Scholar
  • 13 Marshall PS, Cain H. Upper extremity deep vein thrombosis. Clin Chest Med 2010; 31 (04) 783-797
    CrossrefPubMedGoogle Scholar
  • 14 Malinoski DJ, Ewing T, Patel MS. , et al. The natural history of upper extremity deep venous thromboses in critically ill surgical and trauma patients: what is the role of anticoagulation?. J Trauma 2011; 71 (02) 316-321
    CrossrefPubMedGoogle Scholar
  • 15 Lee JA, Zierler BK, Zierler RE. The risk factors and clinical outcomes of upper extremity deep vein thrombosis. Vasc Endovascular Surg 2012; 46 (02) 139-144
    CrossrefPubMedGoogle Scholar
  • 16 Winters JP, Callas PW, Cushman M, Repp AB, Zakai NA. Central venous catheters and upper extremity deep vein thrombosis in medical inpatients: the Medical Inpatients and Thrombosis (MITH) Study. J Thromb Haemost 2015; 13 (12) 2155-2160
    CrossrefPubMedGoogle Scholar
  • 17 Greene MT, Flanders SA, Woller SC, Bernstein SJ, Chopra V. The association between PICC use and venous thromboembolism in upper and lower extremities. Am J Med 2015; 128 (09) 986-993
    CrossrefPubMedGoogle Scholar
  • 18 Spencer FA, Emery C, Lessard D, Goldberg RJ. ; Worcester Venous Thromboembolism Study. Upper extremity deep vein thrombosis: a community-based perspective. Am J Med 2007; 120 (08) 678-684
    CrossrefPubMedGoogle Scholar
  • 19 Flinterman LE, van Hylckama Vlieg A, Rosendaal FR, Doggen CJM. Recurrent thrombosis and survival after a first venous thrombosis of the upper extremity. Circulation 2008; 118 (13) 1366-1372
    CrossrefPubMedGoogle Scholar
  • 20 Klitfod L, Broholm R, Baekgaard N. Deep venous thrombosis of the upper extremity. A review. Int Angiol 2013; 32 (05) 447-452
    PubMedGoogle Scholar
  • 21 Arnhjort T, Persson LM, Rosfors S, Ludwigs U, Lärfars G. Primary deep vein thrombosis in the upper limb: a retrospective study with emphasis on pathogenesis and late sequelae. Eur J Intern Med 2007; 18 (04) 304-308
    CrossrefPubMedGoogle Scholar
  • 22 Levy MM, Bach C, Fisher-Snowden R, Pfeifer JD. Upper extremity deep venous thrombosis: reassessing the risk for subsequent pulmonary embolism. Ann Vasc Surg 2011; 25 (04) 442-447
    CrossrefPubMedGoogle Scholar
  • 23 Tadlock MD, Chouliaras K, Kennedy M. , et al. The origin of fatal pulmonary emboli: a postmortem analysis of 500 deaths from pulmonary embolism in trauma, surgical, and medical patients. Am J Surg 2015; 209 (06) 959-968
    CrossrefPubMedGoogle Scholar
  • 24 Newton DH, Monreal Bosch M, Amendola M. , et al; RIETE Investigators. Analysis of noncatheter-associated upper extremity deep venous thrombosis from the RIETE registry. J Vasc Surg Venous Lymphat Disord 2017; 5 (01) 18-24.e1
    PubMedGoogle Scholar
  • 25 Spirk D, Aujesky D, Stuck AK. , et al. Clinical outcomes of venous thromboembolism in patients with and without cancer: the SWIss Venous ThromboEmbolism Register (SWIVTER). Semin Thromb Hemost 2016; 42 (06) 642-649
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Mai C, Hunt D. Upper-extremity deep venous thrombosis: a review. Am J Med 2011; 124 (05) 402-407
    CrossrefPubMedGoogle Scholar
  • 27 Kearon C, Akl EA, Comerota AJ. , et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis. 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2 Suppl): e419S-e494S
    CrossrefPubMedGoogle Scholar
  • 28 Kearon C, Akl EA, Ornelas J. , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedGoogle Scholar
  • 29 Weitz JI, Haas S, Ageno W. , et al. Global Anticoagulant Registry in the Field - Venous Thromboembolism (GARFIELD-VTE). Rationale and design. Thromb Haemost 2016; 116 (06) 1172-1179
    Article in Thieme ConnectPubMedGoogle Scholar
  • 30 Schulman S, Kearon C. ; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3 (04) 692-694
    CrossrefPubMedGoogle Scholar
  • 31 Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94 (446) 496-509
    CrossrefPubMedGoogle Scholar
  • 32 Kleinjan A, Di Nisio M, Beyer-Westendorf J. , et al. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis: a prospective management study. Ann Intern Med 2014; 160 (07) 451-457
    CrossrefPubMedGoogle Scholar
  • 33 Di Nisio M, Van Sluis GL, Bossuyt PM, Büller HR, Porreca E, Rutjes AW. Accuracy of diagnostic tests for clinically suspected upper extremity deep vein thrombosis: a systematic review. J Thromb Haemost 2010; 8 (04) 684-692
    CrossrefPubMedGoogle Scholar
  • 34 Czihal M, Hoffmann U. Upper extremity deep venous thrombosis. Vasc Med 2011; 16 (03) 191-202
    CrossrefPubMedGoogle Scholar
  • 35 Ouriel K, Green RM, Greenberg RK, Clair DG. The anatomy of deep venous thrombosis of the lower extremity. J Vasc Surg 2000; 31 (05) 895-900
    CrossrefPubMedGoogle Scholar
  • 36 Thijs W, Rabe KF, Rosendaal FR, Middeldorp S. Predominance of left-sided deep vein thrombosis and body weight. J Thromb Haemost 2010; 8 (09) 2083-2084
    CrossrefPubMedGoogle Scholar
  • 37 Lyman GH, Khorana AA, Kuderer NM. , et al; American Society of Clinical Oncology Clinical Practice. Venous thromboembolism prophylaxis and treatment in patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol 2013; 31 (17) 2189-2204
    CrossrefPubMedGoogle Scholar
  • 38 Jones MA, Lee DY, Segall JA. , et al. Characterizing resolution of catheter-associated upper extremity deep venous thrombosis. J Vasc Surg 2010; 51 (01) 108-113
    CrossrefPubMedGoogle Scholar
  • 39 Decousus H, Bourmaud A, Fournel P. , et al; ONCOCIP Investigators. Cancer-associated thrombosis in patients with implanted ports: a prospective multicenter French cohort study (ONCOCIP). Blood 2018; 132 (07) 707-716
    CrossrefPubMedGoogle Scholar
  • 40 Rathbun SW, Stoner JA, Whitsett TL. Treatment of upper-extremity deep vein thrombosis. J Thromb Haemost 2011; 9 (10) 1924-1930
    CrossrefPubMedGoogle Scholar