Yugo Yamashita1, Takeshi Morimoto2, Hidewo Amano3, Toru Takase4, Seiichi Hiramori5, Kitae Kim6, Maki Oi7, Masaharu Akao8, Yohei Kobayashi9, Mamoru Toyofuku10, Toshiaki Izumi11, Tomohisa Tada12, Po-Min Chen13, Koichiro Murata14, Yoshiaki Tsuyuki15, Syunsuke Saga16, Yuji Nishimoto16, Tomoki Sasa17, Jiro Sakamoto18, Minako Kinoshita19, Kiyonori Togi20, Hiroshi Mabuchi21, Kensuke Takabayashi22, Yusuke Yoshikawa1, Hiroki Shiomi1, Takao Kato1, Takeru Makiyama1, Koh Ono1, Takeshi Kimura23. 1. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. 2. Department of Clinical Epidemiology, Hyogo College of Medicine, Nishinomiya, Japan. 3. Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan. 4. Department of Cardiology, Kinki University Hospital, Osaka, Japan. 5. Department of Cardiology, Kokura Memorial Hospital, Kokura, Japan. 6. Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan. 7. Department of Cardiology, Japanese Red Cross Otsu Hospital, Otsu, Japan. 8. Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan. 9. Department of Cardiovascular Center, Osaka Red Cross Hospital, Osaka, Japan. 10. Department of Cardiology, Japanese Red Cross Wakayama Medical Center, Wakayama, Japan. 11. Cardiovascular Center, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan. 12. Department of Cardiology, Shizuoka General Hospital, Shizuoka, Japan. 13. Department of Cardiology, Osaka Saiseikai Noe Hospital, Osaka, Japan. 14. Department of Cardiology, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. 15. Division of Cardiology, Shimada Municipal Hospital, Shimada, Japan. 16. Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan. 17. Department of Cardiology, Kishiwada City Hospital, Kishiwada, Japan. 18. Department of Cardiology, Tenri Hospital, Tenri, Japan. 19. Department of Cardiology, Nishikobe Medical Center, Kobe, Japan. 20. Division of Cardiology, Nara Hospital, Kinki University Faculty of Medicine, Ikoma, Japan. 21. Department of Cardiology, Koto Memorial Hospital, Higashiomi, Japan. 22. Department of Cardiology, Hirakata Kohsai Hospital, Hirakata, Japan. 23. Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan. Electronic address: taketaka@kuhp.kyoto-u.ac.jp.
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.
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.
Authors: Marcela Juliano Silva Cunha; Carlos Augusto Ventura Pinto; João Carlos de Campos Guerra; Adriano Tachibana; Maria Fernanda Cassino Portugal; Leonardo José Rolim Ferraz; Nelson Wolosker Journal: J Vasc Bras Date: 2021-06-11