Upper extremity deep venous thrombosis: an underrecognized manifestation of a hypercoagulable state

Although lower extremity deep venous thrombosis (LEDVT) has been associated with a hypercoagulable state, there are scant data available for patients presenting with upper extremity deep venous thrombosis (UEDVT). Therefore, we conducted a prospective study to determine whether such an association exists for UEDVT. Fifty-two patients who presented with UEDVT at our institution from August 1996 to June 1997 underwent a hematological profile consisting of activated protein C (APC) resistance, antithrombin III (ATIII) level and activity, factor V mutation (arginine 506 to glycine), protein C level and activity, protein S level and activity, factors II and X activity, lupus anticoagulant, and cardiolipin antibody. This represented 68% (52/76) of the total number of patients in whom the diagnosis of UEDVT was made by duplex ultrasonography during this time period. The ages ranged from 9 to 97 (mean 63 +/- 23 years). There were 22 males and 30 females. Twenty-five patients (48%) had a central venous line in place, 4 patients (8%) had a pacemaker, 14 patients (27%) had a history of neoplasm, and 7 patients (13%) had concomitant LEDVT. The results of our study showed that a hypercoagulable state may be an underappreciated contributing factor in the development of UEDVT. Contrary to prior belief that three sets of tests are needed to confirm the presence of a hypercoagulable state, these data also suggest that only two tests may be needed.