Study objectives: To determine the prevalence of
endogenous and exogenous risk factors for venous thrombosis in patients
with upper limb deep vein thrombosis (DVT), and to evaluate the risk of
clinically detectable pulmonary embolus, recurrent DVT, and
postphlebitic symptoms in these patients.
combined prospective and retrospective descriptive analysis of a cohort
of patients with upper limb DVT compared with age- and sex-matched
patients with lower limb DVT.
Setting: Internal medicine
departments, and hematology and vascular surgery outpatient clinics at
a tertiary-care university hospital.
Consecutive patients with “spontaneous” upper limb DVT diagnosed
between 1989 and 1997 were studied. Twenty age- and sex-matched
patients with lower limb DVT admitted to the hospital via the emergency
department served as control patients.
patients with upper limb DVT were studied. An endogenous risk factor
(thrombophilia) was present in 11 of 18 patients vs 8 of 20 control
patients (p = not significant). In the upper limb group, nine
patients had activated protein C resistance, four patients had
anticardiolipin antibodies, and two patients had both forms of
thrombophilia. Furthermore, 14 of the upper limb DVT patients were
found to have an exogenous risk factor for thrombosis compared with 7
of the patients with lower limb DVT (p = 0.01), and 66.6% of
patients with upper limb DVT had both an exogenous and an endogenous
risk factor for thrombosis vs 15% of patients with lower limb DVT
(p < 0.002). No clinically detectable pulmonary emboli occurred
among the upper limb DVT patients. Three patients have minor
postphlebitic symptoms. Two patients experienced recurrent
Conclusion: In the majority of patients with upper
limb DVT that we studied in this relatively small study, exogenous
(environmental) or endogenous risk factors for venous thrombosis, or a
combination of both, were found. Furthermore, in our patients, these
thromboses had a low propensity to cause clinically significant
pulmonary embolus and did not cause significant postphlebitic symptoms.
Finally, we suggest that anticoagulant therapy for these thromboses may
be adequate and that thrombolytic agents and surgical intervention are
not routinely indicated.