Deep vein thrombosis in upper extremities: Clinical characteristics, management strategies and long-term outcomes from the COMMAND VTE Registry. Issue 177 (May 2019)

• Record Type: Journal Article
• Authors: Yamashita, Yugo; Morimoto, Takeshi; Amano, Hidewo; Takase, Toru; Hiramori, Seiichi; Kim, Kitae; Oi, Maki; Akao, Masaharu; Kobayashi, Yohei; Toyofuku, Mamoru; Izumi, Toshiaki; Tada, Tomohisa; Chen, Po-Min; Murata, Koichiro; Tsuyuki, Yoshiaki; Saga, Syunsuke; Nishimoto, Yuji; Sasa, Tomoki; Sakamoto, Jiro; Kinoshita, Minako; Togi, Kiyonori; Mabuchi, Hiroshi; Takabayashi, Kensuke; Yoshikawa, Yusuke; Shiomi, Hiroki; Kato, Takao; Makiyama, Takeru; Ono, Koh; Kimura, Takeshi
• Is Part Of: Thrombosis research. Issue 177(2019)
• Page Start: 1
• Page End: 9
• Publication Date: 2019-05
• Subjects: CI confidence interval -- CT computed tomography -- DVT deep vein thrombosis -- HR hazard ratio -- IQR interquartile range -- PE pulmonary embolism -- VTE venous thromboembolism; Deep vein thrombosis -- Upper -- Recurrence -- Bleeding -- Mortality; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2019.02.029
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: There is a paucity of data on patients with deep vein thrombosis (DVT) in upper extremities. Materials and methods: The COMMAND VTE Registry is a retrospective multicenter registry enrolling 3027 consecutive patients with acute symptomatic venous thromboembolism (VTE) in Japan. The current study population included 2498 patients with upper or lower extremities DVT. Results: There were 74 patients (3.0%) with upper extremities DVT and 2424 patients with lower extremities DVT. Patients with upper extremities DVT more often had active cancer (58%) and central venous catheter use (22%). The proportion of concomitant pulmonary embolism at diagnosis was lower in patients with upper extremities DVT than in those with lower extremities DVT (14% and 51%, P < 0.001). Discontinuation of anticoagulation therapy was more frequent in patients with upper extremities DVT (63.8% and 29.8% at 1-year, P < 0.001). The cumulative 3-year incidence of recurrent VTE was not different between the 2 groups (9.8% and 7.4%, P = 0.43). After adjusting confounders, the risks of upper extremities DVT relative to lower extremities DVT for recurrent VTE remained insignificant (HR 0.94, 95%CI 0.36–2.01, P = 0.89). Conclusions: The prevalence of patients with DVT in upper extremities was 3.0% in the current large-scale real-world registry. Patients with DVT in upper extremities more often had active cancer at diagnosis and central venous catheter use as a transient risk factor for VTE, and less often had concomitant PE. Patients with DVT in upper extremities had similar long-term risk for recurrent VTE as those with DVT in lower extremities despite shorter duration of anticoagulation. Highlights: Deep vein thrombosis (DVT) patients in upper extremities accounted for 3.0% They more often had active cancer and central venous catheter use at diagnosis. They less often had concomitant pulmonary embolism at diagnosis. They had similar long-term risk for recurrence as those in lower extremities.