Risk Factors and Recurrence Rate of Primary Deep Vein Thrombosis of the Upper Extremities

Abstract

Background-One third of cases of upper-extremity deep vein thrombosis (DVT) are primary, ie, they occur in the absence of central venous catheters or cancer. Risk factors for primary upper-extremity DVT are not well established, and the recurrence rate is unknown. Methods and Results-We studied 115 primary upper-extremity DVT patients and 797 healthy controls for the presence of thrombophilia due to factor V Leiden, prothrombin G20210A, antithrombin, protein C, protein S deficiency, and hyperhomocysteinemia. Transient risk factors for venous thromboembolism were recorded. Recurrent upper-extremity DVT was evaluated prospectively over a median of 5.1 years of follow-up. The adjusted odds ratio for upper-extremity DVT was 6.2 (95% CI 2.5 to 15.7) for factor V Leiden, 5.0 (95% CI 2.0 to 12.2) for prothrombin G20210A, and 4.9 (95% CI 1.1 to 22.0) for the anticoagulant protein deficiencies. Hyperhomocysteinemia and oral contraceptives were not associated with upper-extremity DVT. However, in women with factor V Leiden or prothrombin G20210A who were taking oral contraceptives, the odds ratio for upper-extremity DVT was increased up to 13.6 (95% CI 2.7 to 67.3). The recurrence rate was 4.4% patient-years in patients with thrombophilia and 1.6% patient-years in those without thrombophilia. The hazard ratio for recurrent upper-extremity DVT in patients with thrombophilia compared with those without was 2.7 (95% CI 0.7 to 9.8). Conclusions-Inherited thrombophilia is associated with an increased risk of upper-extremity DVT. Oral contraceptives increase the risk only when combined with inherited thrombophilia. The recurrence rate of primary upper-extremity DVT is low but tends to be higher in patients with thrombophilia than in those without.

Risk factors for thrombophilia in extrahepatic portal vein obstruction†

“…These findings strengthen the concept of specific risk factors for different thrombotic sites. 20 For example, oral contraceptives alone increase the risk of lower limb DVT 5 and cerebral vein thrombosis, 15 but not that of upper limb DVT 21 and of EHPVO. To our knowledge, the portal vein is the only venous thrombotic site in which the two gain-of-function mutations factor V Leiden and the prothrombin G20210A, both leading to blood hypercoagulability, seem to play a different role.…”

Trombose venosa profunda de membros superiores: estudo coorte retrospectivo de 52 casos

“…Alguns autores observaram prevalência expressiva de trombofilia nos pacientes com TVPMS, com razão de chances (odds ratio) de 4,09 nos pacientes com TVP idiopática, em relação aos casos de trombose de esforço 10 . Martinelli et al 14 observaram, em TVPMS primárias, razão de chances de 6,2 (95%, intervalo de confiança 2,5 a 15,7) para o fator V Leiden; de 5 (95%, intervalo de confiança 2 a 12) para protrombina G20210A; e 4,9 (95%, intervalo de confiança 1,1 a 22) para deficiência de proteínas anticoagulantes, sendo que somente nesses casos há um aumento na incidência de TVPMS com o uso dos contraceptivos orais 14 . Nos casos do presente estudo, essas determinações não foram feitas.…”

Trombose isolada de veia braquial em paciente com hiper-homocisteinemia

“…At 15-day follow-up, Hyperhomocysteinemia, which is a disorder of homocysteine metabolism, has recently been recognized as a risk factor for thromboembolic disease 5 . Homocysteine is a by-product of sulfurcontaining amino acids and in excess it appears to be related to endothelial damage caused by oxidative and inflammatory mechanisms, and by reducing bioavailability of nitric oxide, which is a powerful endogenous vasodilator [4][5][6][7][8] . The homozygous methylenetetrahydrofolate reductase C677T mutation detected in our patient is related to high plasma homocysteine concentrations (phenotypical expression) and hyperhomocysteinemia confers even higher risks of thromboembolic phenomena such as DVT, pulmonary embolism, myocardial infarction and ischemic cerebral vascular accidents.…”

“…In contrast, other choose to treat the first event for 3 to 12 months during the acute phase and only prescribe continual anticoagulation in cases of repeat thrombosis. High risk patients (two or more thrombosis episodes, atypical site, a DVT and more than one genetic mutations, cancer patients, and others) should be considered for indefinite anticoagulation in order to avoid recurrence 5,9 .…”