Comparisons Between Upper and Lower Extremity Deep Vein Thrombosis: A Review of the RIETE Registry

Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the...

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Bibliographic Details
Published in:Clinical and applied thrombosis/hemostasis 2017-10, Vol.23 (7), p.748-754
Main Authors: Cote, Lauren P., Greenberg, Steven, Caprini, Joseph A., Tafur, Alfonso, Choi, Chris, Muñoz, Francisco J., Skride, Andris, Valero, Beatriz, Porras, José Antonio, Ciammaichella, Maurizio, Hernández-Blasco, Luis Manuel, Monreal, Manuel
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Catheters
Catheters - adverse effects
Female
Hemorrhage - etiology
Humans
Lower Extremity - blood supply
Lower Extremity - pathology
Male
Middle Aged
Pulmonary Embolism - etiology
Pulmonary embolisms
Recurrence
Registries
Thrombosis
Treatment Outcome
Upper Extremity - blood supply
Upper Extremity - pathology
Venous Thrombosis - complications
Venous Thrombosis - pathology
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Summary:Background: The outcome of patients with upper extremity deep vein thrombosis (UEDVT) has not been consistently compared with that in patients with lower extremity deep vein thrombosis (LEDVT). Methods: We used the Registro Informatizado de Enfermedad Trombo Embólica (RIETE) registry to compare the outcomes during the course of anticoagulant therapy in patients with UEDVT versus outcomes in patients with LEDVT. Results: As of August 2015, 37,366 patients with acute DVT had been enrolled in RIETE: 35094 (94%) had LEDVT, 1334 (3.6%) non-catheter related UEDVT (672 unprovoked and 662 provoked) and 938 (2.5%) had catheter-related UEDVT. During the course of anticoagulation, patients with unprovoked UEDVT had a higher rate of DVT recurrences (hazard ratio [HR]: 2.22; 95% CI: 1.37-3.43) and a similar rate of PE recurrences or major bleeding than those with unprovoked LEDVT. Patients with non-catheter-related provoked UEDVT had a similar outcome than those with provoked LEDVT. Among patients with UEDVT, those with non-catheter related unprovoked UEDVT had a lower rate of PE recurrences (HR: 0.06; 95% CI: 0-0.35) and major bleeding (HR: 0.20; 95% CI: 0.08-0.46) than those with catheter-related UEDVT or those with non-catheter related provoked UEDVT (HR: 0.10; 95% CI: 0.004-0.60; and 0.22; 95% CI: 0.08-0.52, respectively). On multivariable analysis, any difference had disappeared. Conclusion: During the course of anticoagulation, patients with UEDVT had a similar outcome than those with LEDVT. Among UEDVT patients, there were some differences according to the presence of catheter or additional risk factors for DVT. These differences disappeared after adjusting for potentially confounding variables.
ISSN:1076-0296
1938-2723
DOI:10.1177/1076029616663847