Femoral deep vein thrombosis associated with central venous catheterization

Abstract Heparin-induced thrombocytopenia (HIT) is a transient antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT—either with or without central venous catheter (CVC) use—is unknown. We therefore studied 260 patients with antibody-positive HIT to determine the influence of CVC use on frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and intensive-care unit patients). Compared with the control populations, both upper- and lower-extremity DVTs were found to be associated with HIT. Upper-extremity DVTs occurred more frequently in HIT patients with a CVC (14 of 145 [9.7%]) versus none of 115 (0%) patients without a CVC (P = .000 35). All upper-extremity DVTs occurred at the CVC site (right, 12; left, 2; kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.

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Endovascular thrombolysis to salvage central venous access in children with catheter-associated upper extremity deep vein thrombosis: technique and initial results

Journal of Thrombosis and Thrombolysis ◽

10.1007/s11239-015-1209-3 ◽

2015 ◽

Vol 40 (3) ◽

pp. 274-279 ◽

Cited By ~ 5

Author(s):

Matthew P. Lungren ◽

Thomas J. Ward ◽

Manish N. Patel ◽

John M. Racadio ◽

Kamlesh Kukreja

Keyword(s):

Deep Vein Thrombosis ◽

Upper Extremity ◽

Central Venous Access ◽

Venous Access ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein ◽

Initial Results

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Upper-extremity deep vein thrombosis related to central venous port systems implanted in cancer patients

British Journal of Radiology ◽

10.1259/bjr/41019720 ◽

2010 ◽

Vol 83 (994) ◽

pp. 850-853 ◽

Cited By ~ 14

Author(s):

S Yukisawa ◽

Y Fujiwara ◽

Y Yamamoto ◽

T Ueno ◽

K Matsueda ◽

...

Keyword(s):

Deep Vein Thrombosis ◽

Cancer Patients ◽

Upper Extremity ◽

Central Venous ◽

Vein Thrombosis ◽

Central Venous Port ◽

Venous Port ◽

Port Systems ◽

Deep Vein

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Upper Extremity Deep Vein Thrombosis - Incidence, Risk Factors, and Management. The Worcester Venous Thromboembolism Study.

Blood ◽

10.1182/blood.v106.11.584.584 ◽

2005 ◽

Vol 106 (11) ◽

pp. 584-584

Author(s):

Frederick A. Spencer3 ◽

Robert J. Goldberg ◽

Darleen Lessard ◽

Cathy Emery ◽

Apar Bains ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Central Venous Catheter ◽

Lower Extremity ◽

Upper Extremity ◽

Venous Catheter ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: Recent observations suggest that upper extremity deep vein thrombosis (DVT) has become more common over the last few decades. However the prevalence of this disorder within the community has not been established. The purpose of this study was to compare the occurrence rate, risk factor profile, management strategies, and hospital outcomes in patients with upper versus lower extremity DVT in a cohort of all Worcester residents diagnosed with venous thromboembolism (VTE) in 1999. Methods: The medical records of all residents from the Worcester, MA statistical metropolitan area (2000 census=478,000) diagnosed with ICD-9 codes consistent with possible DVT and/or pulmonary embolism at all 11 Worcester hospitals during the years 1999, 2001, and 2003 are being reviewed by trained data abstractors. Validation of each case of VTE is performed using prespecified criteria. Results: A total of 483 cases have been validated as acute DVT events - this represents all cases of DVT occurring in residents of the Worcester SMSA in 1999. For purposes of this analysis we have excluded 4 patients with both upper and lower extremity DVT. Upper extremity DVT was diagnosed in 68 (14.2%) of patients versus 411 (85.8%) cases of lower extremity DVT. Patients with upper extremity DVT were younger, more likely to be Hispanic, more likely to have renal disease and more likely to have had a recent central venous catheter, infection, surgery, ICU stay, or chemotherapy than patients with lower extremity DVT. They were less likely to have had a prior DVT or to have developed their current DVT as an outpatient. Although less likely to be treated with heparin, LMWH, or warfarin they were more likely to suffer major bleeding complications. Recurrence rates of VTE during hospitalization were very low in both groups. Conclusions: Patients with upper extremity DVT comprise a small but clinically important proportion of all patients with DVT in the community setting. Their risk profiles differs from patients with lower extremity DVT suggesting strategies for DVT prophylaxis and treatment for this group may need to be tailored. Characteristics of Patients with Upper versus Lower Extremity DVT Upper extremity (n=68) Lower extremity (n=417) P value *Recent = < 3 months Demographics Mean Age, yrs 59.3 66.5 <0.001 Male (%) 51.5 45 NS Race (%) <0.05 White 86.6 91.6 Black 1.5 3.2 Hispanic 9.0 2.0 VTE Setting (%) <0.001 Community 53.8 76.2 Hospital Acquired 46.2 23.8 Risk Factors (%) Recent Central Venous Catheter 61.8 11.9 <0.001 Recent Infection 48.5 32.4 <0.01 Recent Surgery 47.8 28.1 <0.001 Cancer 44.1 32.6 0.06 Recent Immobility 38.2 47.0 NS Recent chemotherapy 25 9.5 <0.001 Renal disease 23.5 1.7 <0.0001 Recent ICU discharge 23.5 15.1 0.07 Recent CHF 19.1 16.6 NS Previous DVT 3.0 18.7 <0.01 Anticoagulant prophylaxis (%) During hospital admission (n=125) 76.7 71.6 NS During recent prior hospital admission (n=188) 73.7 54.7 <0.05 During recent surgery (n=146) 62.5 55.3 NS Hospital therapy - treatment doses (%) Any heparin/LMWH 66.2 82 <0.01 Warfarin at discharge 53.1 71.2 <0.01 Hospital Outcomes (%) Length of stay (mean, d) 11.2 6.8 <0.01 Major bleeding 11.8 4.9 <0.05 Recurrent DVT 1.5 1.0 NS Recurrent PE 0 0.2 NS Hospital Mortality 4.5 4.1 NS

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Characteristics of Upper Extremity Deep Vein Thrombosis in Hospitalized Patients. a Review of 8350 Admissions from the 2012 National Inpatient Sample

Blood ◽

10.1182/blood.v126.23.2314.2314 ◽

2015 ◽

Vol 126 (23) ◽

pp. 2314-2314

Author(s):

Taeha Kim ◽

Joseph Shatzel ◽

Deborah L Ornstein

Keyword(s):

Deep Vein Thrombosis ◽

Venous Catheter ◽

Hospitalized Patients ◽

Catheter Placement ◽

Red Blood Cell Transfusion ◽

National Inpatient Sample ◽

Central Venous ◽

Central Venous Catheter Placement ◽

Vein Thrombosis ◽

Deep Vein

Abstract Background: The incidence of upper extremity deep vein thrombosis (UEDVT) is increasing due to the increased use of central venous catheters. In contrast to lower extremity DVT (LEDVT), there is limited data to guide management, with many current management recommendations based on extrapolation from LEDVT studies. The aim of this study is to evaluate the characteristics and mortality associated with hospitalized patients with UEDVT from a large national database. Methods: Using the 2012 National Inpatient Sample (NIS), admissions with the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code for UEDVT (453.82) were extracted, and data collected on age, sex, length of stay, mortality, and associated diagnoses and procedures. LEDVT (ICD-9-CM 453.40) data were extracted for comparison. Collected data were used to calculate odds ratios with corresponding 95% confidence intervals and p-values to show associations where applicable. Results: Of the 7,296,968 unweighted admissions in the 2012 NIS, 8,350 were associated with UEDVT, and 18,194 were associated with LEDVT (prevalence of 0.11% vs 0.25%, respectively). UEDVT and LEDVT rates were similar in men and women. However, compared to LEDVT, patients with UEDVT were younger (61yr vs. 67 yr; p<0.0001), had longer mean LOS (14 days (range 0-309) vs. 5 days (range 0-345); p<0.0001), and higher inpatient mortality (7.75% vs 5.34%; OR 1.45, 95% CI 1.31, 1.61; p<0.0001). Pulmonary embolism was less common in UEDVT than in LEDVT (6.2% vs. 25%; OR 0.24, 95% CI 0.22, 0.27; p<0.0001), but significantly more common than the general hospitalized population (6.2% vs. 0.08%; OR 7.7, 95% CI 7.04, 8.42; p<0.0001). Malignancy was slightly more common in patients with UEDVT compared to those with LEDVT (30.1% vs 27.1%; OR 1.11, 95% CI 1.05, 1.17; p=0.0002). UEDVT was associated with central venous catheter placement (OR 10.1, 95% CI 9.56, 10.68; p<0.0001), other venous catheter placement (OR 21.9, 95% CI 20.9, 22.9; p<0.0001), and red blood cell transfusion (OR 3.6, 95% CI 3.47, 3.83; p<0.0001) in the hospitalized population. Procedures most commonly associated with LEDVT were interruption of the vena cava, red blood cell transfusion and other venous catheter placement. Conclusions: UEDVT was less common than LEDVT, and associated with central venous catheter placement and blood transfusions in hospitalized patients. UEDVT tended to occur in younger patients with longer LOS, and was associated with a higher mortality and a slightly higher prevalence of malignancies than LEDVT. PE was less common during admissions with UEDVT than LEDVT, however UEDVT admissions were associated with an increased incidence of PE compared to the general inpatient population. The results of this large epidemiologic study of UEDVT in hospitalized patients contribute to our understanding of this increasingly common disease and will help define strategies for prophylaxis and treatment. Disclosures No relevant conflicts of interest to declare.

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Deep vein thrombosis associated with central venous catheters - a review

Journal of Thrombosis and Haemostasis ◽

10.1111/j.1538-7836.2005.01398.x ◽

2005 ◽

Vol 3 (11) ◽

pp. 2409-2419 ◽

Cited By ~ 97

Author(s):

C. J. ROODEN ◽

M. E. T. TESSELAAR ◽

S. OSANTO ◽

F. R. ROSENDAAL ◽

M. V. HUISMAN

Keyword(s):

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Vein Thrombosis ◽

Deep Vein

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Prevalence and Predictors of Deep Vein Thrombosis in Critically Ill Medical Patients Who Underwent Diagnostic Duplex Ultrasonography

Journal of Intensive Care Medicine ◽

10.1177/0885066618813300 ◽

2018 ◽

Vol 35 (10) ◽

pp. 1062-1066 ◽

Cited By ~ 2

Author(s):

Charlisa D. Gibson ◽

Mai O. Colvin ◽

Michael J. Park ◽

Qingying Lai ◽

Juan Lin ◽

...

Keyword(s):

Mechanical Ventilation ◽

Deep Vein Thrombosis ◽

Central Venous Catheters ◽

Central Venous ◽

Mechanical Prophylaxis ◽

Vein Thrombosis ◽

Icu Length Of Stay ◽

History Of ◽

Deep Vein ◽

Chemical Prophylaxis

Introduction: Deep vein thrombosis (DVT) is a recognized but preventable cause of morbidity and mortality in the medical intensive care unit (MICU). We examined the prevalence and risk factors for DVT in MICU patients who underwent diagnostic venous duplex ultrasonography (DUS) and the potential effect on clinical outcomes. Methods: This is a retrospective study examining prevalence of DVT in 678 consecutive patients admitted to a tertiary care level academic MICU from July 2014 to 2015. Patients who underwent diagnostic DUS were included. Potential conditions of interest were mechanical ventilation, hemodialysis, sepsis, Sequential Organ Failure Assessment (SOFA) scores, central venous catheters, prior DVT, and malignancy. Primary outcomes were pulmonary embolism, ICU length of stay, and mortality. Additionally, means of thromboprophylaxis was compared between the groups. Multivariable logistic regression analysis was utilized to determine predictors of DVT occurrence. Results: Of the 678 patients, 243 (36%) patients underwent DUS to evaluate for DVT. The prevalence of DVT was 16% (38) among tested patients, and a prior history of DVT was associated with DVT prevalence ( P < .01). Between cases and controls, there were no significant differences in central venous catheters, mechanical ventilation, hemodialysis, sepsis, SOFA scores, malignancy, and recent surgery. Patients receiving chemical prophylaxis had fewer DVTs compared to persons with no prophylaxis (14% vs 29%; P = .01) and persons with dual chemical and mechanical prophylaxis ( P = 0.1). Fourteen percent of patients tested had documented DVT while on chemoprophylaxis. There were no significant differences in ICU length of stay ( P = .35) or mortality ( P = .34). Conclusions: Despite the appropriate use of universal thromboprophylaxis, critically ill nonsurgical patients still demonstrated high rates of DVT. A history of DVT was the sole predictor for development of proximal DVT on DUS testing. Dual chemical and mechanical prophylaxis does not appear to be superior to single-chemical prophylaxis in DVT prevention in this population.

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