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 PS144. Rare Incidence of Pulmonary Embolism Following Upper Extremity DVT (UEDVT) Suggests Role for More Selective Anticoagulation

​Mark M. Levy, Francisco C. Albuquerque, Michael F. Amendola, Derek R. Brinster, John Pfeifer
Surgery, Virginia Commonwealth University, Richmond, VA.

OBJECTIVES: Current Chest guidelines counsel at least 3 months of anticoagulation (AC) to treat UEDVTs, yet are not consistently followed among fragile patients. We sought to correlate AC use with DVT characteristics and patient outcomes.

METHODS: Four hundred consecutive UEDVT patients were identified between 2005 and 2009 from our Vascular Lab Registry. Sonographic and patient characteristics, AC treatment, PE incidence, mortality and hemorrhagic complications were reviewed.

RESULTS: Among the 400 patients, UEDVT was documented in the distal innominate (n=91), internal jugular (n=192), subclavian (n=211), axillary (n=146), and brachial veins (n=125). Most were symptomatic (n=350, 88%), with sonographically acute appearance (n=335, 84%). Many patients had documented malignancy (n=153, 38%), or associated central venous lines (n=323, 81%), and most were treated with heparin and/or warfarin. (n=207, 52%).
Thirteen patients (3%) suffered PE in association with their UEDVT diagnosis. There was no PE-related mortality. Following discharge, 4 patients treated with warfarin died from intracranial hemorrhage. Five additional patients required hospital readmission for AC-related intracranial, GI, and stomal hemorrhage.

CONCLUSIONS: AC is most commonly used to treat more extensive acute DVT components in younger patients with better short-term survival. The incidence of PE does not appear to be improved by AC treatment. Given the observed morbidity and mortality associated with AC, and the small risk of PE, the practice of more limited and selective AC to treat UEDVT seems warranted.

AUTHOR DISCLOSURES: F. C. Albuquerque, Nothing to disclose; M. F. Amendola, Nothing to disclose; D. R. Brinster, Nothing to disclose; M. M. Levy, Nothing to disclose; J. Pfeifer, Nothing to disclose.

Comparison of Patient and UEDVT Characteristics Among Anticoagulated and Nonanticoagulated Patients

Patient/DVT Characteristic
AC (+)
AC (-)
p-Value
Patient Age
48+/-18
54+/-17
.002*
Death at 3 months
26/107 (13%)
51/193 (26%)
<0.001**
UEDVT associated PE
11/207 (5%)
2/193 (1%)
0.02**
# named DVT segments
2.1+/-1.2
1.7+/-1.0
<0.001**
Acute DVT Component
185/207 (89%)
148/193 (77%)
<0.001**

*t-test; **Chi-square

 

Posted April 2012

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