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Outcomes, treatment strategies vary among patients with upper extremity venous thrombosis
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The risk for recurrent venous thromboembolism appeared low for patients with upper extremity deep vein thrombosis and almost nonexistent for patients with upper extremity superficial vein thrombosis, according to the results of a prospective diagnostic management study.
However, mortality rates remained high in both conditions, and the use of anticoagulation resulted in a substantial major bleeding risk among patients with upper extremity deep vein thrombosis (UEDVT), results showed.
“No randomized controlled trials have evaluated the treatment of UEDVT or upper extremity superficial vein thrombosis [UESVT],” Suzanne M. Bleker, MD, of the department of vascular medicine at Academic Medical Center in Amsterdam, and colleagues wrote. “Hence, several questions regarding the optimal management of these conditions remain unanswered.”
Bleker and colleagues sought to observe current management strategies used for patients with UEDVT and UESVT and to assess rates of recurrent VTE, mortality, thrombotic symptoms and treatment-related bleeding events in this population.
The researchers collected data from 406 patients with a clinical suspicion of UEDVT for the prospective, multicenter ARMOUR management study. Of the initial cohort, 104 patients had UEDVT, 57 patients had UESVT and 245 had no UEDVT or UESVT.
Forty-three patients with UEDVT and 19 patients with UESVT also had cancer. Common cancers in the UEDVT cohort included breast cancer (29%), gastrointestinal cancers (24%) and hematologic malignancies (19%).
The researchers followed 98% of patients with UEDVT (n = 102; mean age, 54 ± 17 years; 43% men) and 97% of patients with UESVT (n = 55; mean age, 56 ± 17 years; 56% men) for a median duration of 3.5 years (interquartile range [IQR] for UEDVT, 2.9-4; IQR for UESVT, 3.1-4).
One hundred patients with UEDVT (98%) and 40 patients with UESVT (73%) initiated anticoagulation therapy.
Recurrent VTE occurred in nine patients (9%) with UEDVT and one patient with UESVT. Twenty-six patients (26%) with UEDVT and 18 patients with UESVT (33%) died. In both cohorts, the majority of deaths were cancer related (UEDVT, 70%; UESVT, 56%).
Among patients with UEDVT, 8% (n = 6 of 72) had moderate postthrombotic symptoms and 5% (n = 5) had major bleeding episodes. No patients with UESVT experienced postthrombotic symptoms or major bleeding.
A greater percentage of patients with cancer and UEDVT experienced recurrent VTE than patients without cancer (18% vs. 7.5%; adjusted HR = 2.2; 95% CI, 0.46-8.2).
After 3.5 years of follow-up, cumulative survival was 47% in patients with cancer and UEDVT and 58% in those without UEDVT (adjusted HR = 0.8; 95% CI, 0.4-1.4).
The researchers acknowledged study limitations, including the relatively small absolute size of the patient sample, as well as their need to retrospectively collect some data due to patient death or loss to follow-up. Additionally, the study’s outcome events were not centrally adjudicated.
“The overall risk for recurrent VTE during anticoagulant treatment was relatively low in patients with UEDVT and negligible in those with UESVT,” Bleker and colleagues wrote. “Anticoagulant therapy of UEDVT appeared to carry a substantial risk for major bleeding. Patients with cancer had a significant risk for recurrent VTE and may benefit from long anticoagulant therapy.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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