Lauren P Cote1, Steven Greenberg2, Joseph A Caprini3, Alfonso Tafur3, Chris Choi4, Francisco J Muñoz5, Andris Skride6, Beatriz Valero7, José Antonio Porras8, Maurizio Ciammaichella9, Luis Manuel Hernández-Blasco10, Manuel Monreal11. 1. 1 Department of Nursing/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Evanston, IL, USA. 2. 2 Department of Anesthesia/Critical Care, Evanston Hospital, NorthShore University HealthSystem, Chicago, IL, USA. 3. 3 Division of Vascular Surgery, Evanston Hospital, NorthShore University HealthSystem, Chicago, IL, USA. 4. 4 Department of Anesthesiology, Yale-New Haven Hospital, New Haven, CT, USA. 5. 5 Department of Internal Medicine, Fundació Privada Hospital de Mollet, Barcelona, Spain. 6. 6 Department of Cardiology, Ospedale Pauls Stradins Clinical University Hospital, Riga, Latvia. 7. 7 Department of Internal Medicine, Hospital General Universitario de Alicante, Alicante, Spain. 8. 8 Department of Internal Medicine, Hospital Universitario Joan XXIII de Tarragona, Tarragona, Spain. 9. 9 Department of Emergency Internal Medicine, Ospedale St John, Rome, Italy. 10. 10 Department of Pneumonology, Hospital General Universitario de Alicante, Alicante, Spain. 11. 11 Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
Abstract
BACKGROUND: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). METHODS: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. RESULTS: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. CONCLUSION: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.
BACKGROUND: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). METHODS: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. RESULTS: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. CONCLUSION: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.
Authors: Jan Heil; Wolfgang Miesbach; Thomas Vogl; Wolf O Bechstein; Alexander Reinisch Journal: Dtsch Arztebl Int Date: 2017-04-07 Impact factor: 5.594