Predictable Risk Factors of Upper-Extremity Deep Venous Thrombosis in a Level I Trauma Center

Abstract

Background Venous thromboembolism is a common cause of morbidity and mortality in hospital patients, especially that of the lower extremities. Risk factors and diagnostic elements of upper-extremity deep-vein thrombosis (UEDVT) are poorly understood compared to those of the lower extremities. The primary objectives of this study were to identify predictive risk factors of secondary UEDVT. Methods This retrospective study included all nonpregnant patients aged >18 years who had undergone upper-extremity duplex scans to check for the presence of secondary UEDVT at Richmond University Medical Center from January 2014 to March 2020. Patients were stratified by presence or absence of UEDVT. Collected data points included patient demographics, comorbidities, central-line use, platelet count at time of scan, length of stay, and overall mortality. IBM 27.0 was used for all statistical analysis, with p<0.05 considered significant. Results A total of 1,009 upper extremity venous duplex studies were included. There were no significant differences in age, sex, race, or mean platelet levels between patients diagnosed with DVT and those without ( p <0.05). After multinomial regression analysis, central venous catheter (CVC; 26.8% versus 78.5%, aOR 1.770, 95% CI 1.150–2.725; p <0.002), peripherally inserted central catheter (PICC) line (17.5% versus 82.5%, aOR3.254, 95% CI 1.997–5.304; p <0.001), hypertension (67.8% versus 28.8%, aOR 1.641, 95% CI 1.136–2.369; p <0.001), chronic kidney disease (CKD; 34.5% versus 65.5%, aOR 1.743, 95% CI 1.201–2.531; p <0.001), and malignancy (27.1% versus 74.6%, aOR 1.475, 95% CI 0.994–2.190; p <0.053) were found to be independent predictors of UEDVT. Conclusion Use of CVC or PICC line, preexisting diagnosis of hypertension, malignancy, and CKD were independent risk factors of UEDVT, while there was no significant correlation between increased platelet levels and UEDVT.

Obesity increases the risk for upper extremity deep vein thrombosis and pulmonary embolism in patients with upper extremity central venous catheters

“…Our population with lower BMI also had a higher percentage of patients with a malignancy and trauma. Malignancy has been documented to be related to the development of UEVTEs 6 . Trauma patients are also known to be at higher risk of DVT in general 29 .…”

“…While the majority of PEs are thought to arise from DVTs of the lower extremities; there is evidence of risk of PE from upper extremity DVTs (upper extremity venous thromboembolisms [UEVTEs]) as well 2 . While UEVTEs are mostly secondary and associated with direct compression of the vein through anatomic variation, 3 a major risk factor identified for these UEVTEs is the placement of central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), which has been well described 4–7 . Multiple other patient risk factors have been described for UEVTEs related to CVCs, specifically malignancy, recent surgery, renal failure, hypertension, smoking and radiation 6,8–10 .…”

“…While UEVTEs are mostly secondary and associated with direct compression of the vein through anatomic variation, 3 a major risk factor identified for these UEVTEs is the placement of central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), which has been well described 4–7 . Multiple other patient risk factors have been described for UEVTEs related to CVCs, specifically malignancy, recent surgery, renal failure, hypertension, smoking and radiation 6,8–10 . Catheter specific risk factors have also been described, including gauge of PICC, number of lumens and speciality placement 8,11,12 .…”

“…2 While UEVTEs are mostly secondary and associated with direct compression of the vein through anatomic variation, 3 a major risk factor identified for these UEVTEs is the placement of central venous catheters (CVCs) and peripherally inserted central catheters (PICCs), which has been well described. [4][5][6][7] Multiple other patient risk factors have been described…”

Upper extremity deep venous thrombosis prevalence in the NHS Grampian Medical Ambulatory clinic: diagnostic, therapeutic, and prognostic considerations in oncology patients

“…Among the main complications of UL-DVT, unlike lower limb thromboses, it remains increased mortality, recurrent thromboembolism, and post-thrombotic syndrome. The mortality rate in this patient group can range from 10 to 50%, related mainly to the underlying malignancy, and fatal pulmonary embolism which may contribute to the overall mortality [ 13 ]. Our findings, in agreement with recent literature highlighted that use of PICC line, pre-existing cardiovascular conditions, and malignancy, represent independent risk factors of UEDVT [ 14 ].…”