Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta‐analysis

Abstract

Background Data on anticoagulant treatment for upper extremity deep vein thrombosis (UEDVT) are largely derived from studies on usual site venous thromboembolism (VTE). Objectives The objective of this meta‐analysis was to evaluate the efficacy and safety of anticoagulant therapy for UEDVT. Patients/Methods A systematic search of MEDLINE and EMBASE was conducted for studies including patients with UEDVT. Primary outcomes were recurrent VTE and major bleeding. Secondary outcomes included clinically‐relevant non‐major bleeding and all‐cause mortality. Summary estimates with 95% confidence intervals (CIs) were calculated by random‐effect meta‐analysis. Results A total of 1473 patients from 11 prospective and nine retrospective studies were included. Sixty percent of patients had an indwelling catheter and 56.1% had cancer. Anticoagulant treatment consisted of direct oral anticoagulants, low molecular weight heparin followed by vitamin K antagonists, and low molecular weight heparin alone in 45.1%, 35.0%, and 19.9% of patients, respectively. During a median follow‐up of 13 months, recurrent VTE occurred in 3% of patients (95% CI: 2–4; 21/1334 patients), major bleeding in 3% (95% CI: 2%–5%; 29/1235 patients), clinically‐relevant non‐major bleeding in 4% (95% CI: 3–6; 40/1075 patients), and all‐cause mortality in 9% (95% CI: 5–15; 108/1084 patients). Rates of these outcomes were not significantly different between patients with or without cancer, patients with or without an indwelling catheter, and among those receiving different anticoagulant treatments. Conclusions In patients with UEDVT, anticoagulant treatment is associated with a low risk of recurrent VTE and a nonnegligible risk of major bleeding.

A Single Center Retrospective Cohort Study Comparing Different Anticoagulants for the Treatment of Catheter-Related Thrombosis of the Upper Extremities in Women With Gynecologic and Breast Cancer

“…Our results suggest that edoxaban-which is already approved for the treatment of proximal lower-limb DVT and EP in cancer patients-is effective and safe also for CRT of the upper extremities, with preservation of line function and resolution of thrombosis in almost the totality of patients and no evidence of MB and CRNMB. These findings are consistent with the results of a recent meta-analysis published by our group, which has shown that recurrent VTE, MB, and CRNMB are not significantly different in patients with upper extremity DVT who received different types of anticoagulant treatments, even if they are affected by cancer (21). The fact that our data have been obtained in a specific population of women with gynecologic cancer is important, because it provides novel information on a category of patients affected by cancers that are frequently associated with VTE and because CRT often occurs in women receiving chemotherapy for cancer (22).…”

Idiopathic upper extremity deep vein thrombosis: A systematic review

“…A recent systematic review on primary and secondary UEDVT found a low risk of recurrent thrombosis (including UEDVT, LLDVT and PE) of 3% (95% CI 2–4) over 13 months' follow‐up after a mean of 5 months anticoagulation 34 . However, most included patients had secondary UEDVT related to vascular access devices (60.8%) and cancer (56.1%).…”

“…Therefore, in UEDVT, the adverse events from additional interventions do not seem justified. Furthermore, the not insignificant rate of bleeding of 3%-4% annually with long-term anticoagulation 34 In the absence of such research, clinical equipoise remains between anticoagulation alone or more aggressive therapies as well as regarding the duration of anticoagulation to utilise in the management of idiopathic UEDVT.…”

“…Therefore, in UEDVT, the adverse events from additional interventions do not seem justified. Furthermore, the not insignificant rate of bleeding of 3%–4% annually with long‐term anticoagulation 34 needs to be carefully balanced against recurrence risk. Future prospective studies directly comparing fixed duration anticoagulation alone versus anticoagulation with additional interventions and adequate follow‐up of 2–5 years would be ideal.…”

Edoxaban: front-line treatment for brachiocephalic vein thrombosis in primitive mediastinal seminoma: A case report and literature review

“…These findings were consistent across the different subgroups of patients and the different anticoagulant agents. [51] In this case report, we detected ULDVT by US, including compression ultrasound (CUS), color-Doppler and combined techniques, which is the imaging modality test of choice. Indeed, its sensitivity and specificity ranges from 81–97% and 93–96%, respectively.…”