Are we managing primary upper limb deep venous thrombosis aggressively enough in the district?

The objective of this retrospective study was to analyse risk factors, management and outcome of primary upper limb deep venous thrombosis (ULDVT, Paget von Schroetter syndrome) in 4 district hospitals.

The study group audited between May 1995 and January 2004 comprised of 24 patients with primary ULDVTs (8 male, 16 female; age range 21-80 years, mean 46 years).

Common risk factors included smoking (n=8, 33.3%) and hormonal therapy for women (n=4, 25%). Diagnosis was established by duplex ultrasound alone in 13 patients (54.2%), by venogram alone in 9 patients (37.5%) and by both investigations in 2 patients (8.3%). A thrombophilia screen was performed in 19 patients (79.2%) of which 5 patients (20.8%) were identified with a hypercoagulable state. Twenty-three patients were anticoagulated (95.8%). One patient (4.2%) was initially thrombolysed and subsequently anticoagulated. Overall symptoms resolved or improved in 14 patients (58.3%), symptoms persisted in 8 patients (33.3%) and in 2 patients (8.3%) the outcome was not documented. Only one patient was further evaluated and identified as having thoracic outlet compression. Most patients were managed by physicians (n=19 versus surgeons n=5).

This study reveals that most patients with primary ULDVT are treated with anticoagulation alone probably based on protocols for lower limb deep vein thromboses which results in an unacceptable high number of patients (33.3%) with persisting disability. Therefore, we suggest a more proactive approach in such patients with evaluation for thoracic outlet compression.