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2017 ; 114
(14
): 244-249
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Deep Vein Thrombosis of the Upper Extremity
#MMPMID28446351
Heil J
; Miesbach W
; Vogl T
; Bechstein WO
; Reinisch A
Dtsch Arztebl Int
2017[Apr]; 114
(14
): 244-249
PMID28446351
show ga
BACKGROUND: Deep venous thrombosis (DVT) arises with an incidence of about 1 per
1000 persons per year; 4-10% of all DVTs are located in an upper extremity
(DVT-UE). DVT-UE can lead to complications such as post-thrombotic syndrome and
pulmonary embolism and carries a high mortality. METHODS: This review is based on
pertinent literature, published from January 1980 to May 2016, that was retrieved
by a systematic search, employing the PRISMA criteria, carried out in four
databases: PubMed (n = 749), EMBASE (n = 789), SciSearch (n = 0), and the
Cochrane Library (n = 12). Guidelines were included in the search. RESULTS:
DVT-UE arises mainly in patients with severe underlying diseases, especially
cancer (odds ratio [OR] 18.1; 95% confidence interval [9.4; 35.1]). The insertion
of venous catheters-particularly central venous catheters-also elevates the risk
of DVT-UE. Its clinical manifestations are nonspecific. Diagnostic algorithms are
of little use, but ultrasonography is very helpful in diagnosis. DVT-UE is
treated by anticoagulation, with heparin at first and then with oral
anticoagulants. Direct oral anticoagulants are now being increasingly used. The
thrombus is often not totally eradicated. Anticoagulation is generally continued
as maintenance treatment for 3-6 months. Interventional techniques can be used
for special indications. Patients with DVT-UE have a high mortality, though they
often die of their underlying diseases rather than of the DVT-UE or its
complications. CONCLUSION: DVT of the upper extremity is becoming increasingly
common, though still much less common than DVT of the lower extremity. The
treatment of choice is anticoagulation, which is given analogously to that given
for DVT of the lower extremity.
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