Does upper limb deep venous thrombosis have the same significance than lower limb deep venous thrombosis?

PURPOSE: The link between lower limb deep venous thrombosis (L-DVT) and the development of pulmonary emboli (PE) is well established. However, little is known about the significance of upper limb deep venous thrombosis (U-DVT). Our Institution is a cancer hospital, and thereby our patients carry a greater risk for venous thromboembolism for multiple obvious reasons. METHODS: 291 clinical histories of patients who had ventilation/perfusion (V/Q) scans done for the period Jan. 1994 and June 1995 were reviewed retrospectively. The DVT diagnosis, made by clinical findings, ultrasound, contrast or nuclear venogram, was correlated with results of V/Q scans, pulmonary angiograms and autopsies. RESULTS: Of the 291 clinical histories reviewed, 123 cases were found to have DVT, 9 patients had DVT ruled out, and in 159 cases no work up for DVT was done. As depicted in the table, out of the 123 DVT cases, 98 had U-DVT, 22 had L-DVT and 3 had both upper and lower DVT (B-DVT). 36% of the U-DVT's were related to intravenous catheters (IV-Cath). Cath Neop Thro Total P.E. Udvt 35 10 53 98 3 Ldvt 0 2 20 22 12 Bdvt 0 1 2 3 2 CONCLUSIONS: 1) The incidence of U-DVT in cancer patients is high. 2) U-DVT represents a considerably less significant risk factor than L-DVT for the development of PE. 3) More than 1/3 of the U-DVT cases are related to IV-Caths. CLINICAL IMPLICATIONS: The lower incidence of PE in U-DVT might warrant shorter anticoagulation time. The relatively strong relation of U-DVT with IV-Caths indicates the need for manufacturing less thrombogenic catheters.