Risk factors and recurrence rate of primary deep vein thrombosis of the upper extremities

Ida Martinelli ¹, Tullia Battaglioli , Paolo Bucciarelli

⁰Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Department of Internal Medicine and Dermatology, Istituto di Ricovero e Cura a Carattere Scientifico Ospedale Maggiore Policlinico, University of Milano, Italy. martin@policlinico.mi.it

Circulation +

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July 21, 2004

View abstract on PubMed

Summary

Inherited thrombophilia significantly increases the risk of primary upper-extremity deep vein thrombosis (DVT). This risk is further elevated when combined with oral contraceptives, though the recurrence rate for DVT remains low.

Area Of Science

Medical research
Hematology
Vascular medicine

Background

Primary upper-extremity deep vein thrombosis (DVT) accounts for one-third of cases, often without clear risk factors.
Established risk factors for primary upper-extremity DVT are not well-defined, and recurrence rates are unknown.

Purpose Of The Study

To investigate the association between inherited thrombophilia and primary upper-extremity DVT.
To determine the recurrence rate of primary upper-extremity DVT.
To explore the role of oral contraceptives as a risk factor.

Main Methods

A case-control study involving 115 primary upper-extremity DVT patients and 797 healthy controls.
Assessed thrombophilia for factor V Leiden, prothrombin G20210A, antithrombin, protein C, protein S deficiency, and hyperhomocysteinemia.
Prospective follow-up for recurrent upper-extremity DVT over a median of 5.1 years.

Main Results

Factor V Leiden, prothrombin G20210A, and deficiencies in anticoagulant proteins were significantly associated with increased upper-extremity DVT risk.
Oral contraceptives alone were not a risk factor, but combined with factor V Leiden or prothrombin G20210A, they substantially increased DVT risk.
The recurrence rate was higher in patients with thrombophilia (4.4% patient-years) compared to those without (1.6% patient-years).

Conclusions

Inherited thrombophilia is a significant risk factor for primary upper-extremity DVT.
Oral contraceptives potentiate the risk of upper-extremity DVT only when co-occurring with inherited thrombophilia.
Primary upper-extremity DVT has a low recurrence rate, which is higher in individuals with thrombophilia.

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