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

Abstract

Introduction Whilst upper extremity deep vein thromboses (UEDVT) account for approximately 5 to 10% of all cases of DVT, rigorous guidelines regarding diagnosis and management of presenting patients remain to be developed. The association of UEDVT with concurrent asymptomatic pulmonary embolism as well as the first presentation of malignancy deems essential rigorous research and clinical guideline development to ensure optimal patient care. Methods This retrospective audit study is the first to provide estimates of UEDVT prevalence in the North-East Deanery main hospital centre, Aberdeen Royal Infirmary (ARI). Results Of the 605 patients attending the ARI Ambulatory Emergency Care (AEC) clinic with clinical suspicion of UEDVT, 38 (6.2%) had a confirmatory diagnosis. Underlying malignancy, presence of PICC line, and cardiovascular co-morbidities were identified as common confounding factors. Subclavian vein with concurrent extension to primarily the cephalic vein thrombosis was identified as the most commonly thrombosed venous territories. Importantly, oncology patients were found to have poorer survival outcomes following an UEDVT, in comparison to patients with other significant co-morbidities (cardiovascular, chronic renal disease, inflammatory bowel disease): HR 5.814 (95%CI 1.15, 29.25), p 0.012. Lastly, genetic associations were drawn between patient genetic status as tested for other co-morbidities and prothrombotic cellular cascades, suggesting rigorous VTE assessment in patients identified with congenital or acquired mutations, namely, in CALR, JAK, MSH 2/6, MYC, and FXN. Conclusions Overall, this study offers the first report of UEDVT presentations in the UK with no restrictions of patient performance status or underlying co-morbidities and provides a rounded clinical picture of patient characteristics, diagnosis, management, and prognostic associations in view of rigorous guideline development.

Peripherally Inserted Central Line Catheters following Hand and Wrist Infections

“…PICC-related DVT is a well-described and studied topic, and studies have shown that the incidence of DVT can range from 2.4% to 15%. 17,18 This lower rate of DVT in PICC patients may be secondary to patient factors (unlikely to have malignancy, average age in early 1950s, and most likely to be ambulatory) as well as mechanical factors (PICC for antibiotic use typically utilizes single lumen catheter; the duration is usually in the order of weeks). Unfortunately due to the limitations of the mechanism by which we can extract the data based on CPT code, we were unable to identify which complications were truly secondary to PICC placement.…”

Research on risk factors for deep vein thrombosis in elderly patients with upper limb fractures and establishment of Nomogram prediction model

“…The main risk factors for deep vein thrombosis of the upper extremity (DVT-UE) are central venous catheter(CVC), peripherally inserted central venous catheters (PICC), and cardiac pacemakers [31]. Foreign bodies in the vascular system represent the most signi cant independent risk factor for DVT-UE [32].…”

Diagnosis of Deep Vein Thrombosis in Outpatients With Musculoskeletal Disorders: A Survey of Orthopaedic and Sports Academies

“…11-13 Recent literature suggests that the incidence of UE DVT may be higher in patients who are overweight, have cancer, or have recently had a peripherally inserted central catheter (PICC line) inserted to deliver life-saving medications to a patient. 14-16 Interestingly, UE DVT is also possible in younger throwing athletes due to interstitial trauma from the repetitive forces of throwing during baseball that resulted in an effort thrombosis. 17…”