Primary upper‐extremity deep vein thrombosis: High prevalence of thrombophilic defects

Abstract

Primary deep venous thrombosis of the upper extremity (UEDVT) is an unusual disorder. Limited data are available on the contribution of hypercoagulable status in the pathogenesis of this disease. This study aims to report the prevalence of inherited and acquired thrombophilic risk factors (TF) in patients with primary (effort-related and spontaneous) UEDVT. From 1993 to 2002, 31 patients (17 females, median age 38.8 years, range 16-60 years; and 14 males, median age 31.4 years, range 20-56 years) with primary UEDVT (n = 15 effort-related and n = 16 spontaneous) were referred for screening of hypercoagulable status. Nineteen (61.3%) patients had at least one coagulation abnormality. The most common acquired TF were antiphospholipid antibodies (31% lupus anticoagulant and 12.9% anticardiolipin antibodies). Factor V Leiden (12.9%) and prothrombin G20210A mutation (20%) were the most prevalent genetic risk factors. Five patients (16.1%) had high plasma homocysteine levels, and one patient (4.7%) had protein S deficiency. Effortrelated UEDVT was associated with male gender (P = 0.04) and younger age (P = 0.02). There was no significant difference in the prevalence of acquired or inherited TF between patients with effort-related or spontaneous UEDVT. A local anatomic abnormality was detected in seven patients (22.5%), and the prevalence of TF was significantly lower within this group (P = 0.006). The incidence of TF in patients without an anatomic abnormality was 75% (RR 5.25). This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT. Hypercoagulable status may play a significant role in both groups. Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT. Am.

Case Reports: Heritable Thrombophilia Associated with Deep Venous Thrombosis after Shoulder Arthroscopy

“…Upper extremity DVT is an uncommon complication, occurring in less than 4% of patients in whom DVT develops [23]. Risk factors for DVT in this location include acquired or inherited hypercoagulable states, anatomic abnormalities causing venous compression, strenuous upper extremity exercise, cancer, and venous catheterization as with pacemakers [2,7,10,15,21,26,40].…”

Venous thoracic outlet syndrome

“…Additionally, thrombophilia has been identified as a risk factor predisposing to thrombosis in VTOS by several authors. 11,13,14 It is important to mention that, in our experience, VTOS patients are frequently underdiagnosed or misdiagnosed in the community. This may be due to the relatively uncommon nature of the disease and unfamiliarity many practitioners have.…”

“…The studies quote a range of 8% to 67% of patients presenting with primary thrombosis that will test positive for thrombophilia. 11,13,14,26 Recommendations on this topic remain controversial. In a protocol devised by one author, the presence of a prothrombotic state found at the time of primary thrombosis was an indication for lifelong anticoagulation and was also associated with a significantly higher complication rate during therapy.…”

“…10 Most often the right arm is affected, which is thought to be due to a higher proportion of right-handed dominance in society. 1,10,11 Athletes are another population likely to be affected. A recent study from a single institution identified 41 athletes treated for TOS over 13 years.…”

Üst ekstremite derin ven trombozlu hastaların değerlendirilmesi

“…Diğer neden olan faktörler ise: travma, vena kava süperiyor sendromu, tümör, yabancı cisim, polisitemi, trombositoz, konjestif kalp yetersizliği ve pıhtılaşma faktördür [2].…”