Both primary and secondary upper extremity deep vein thrombosis (UEDVT) may be associated with significant rates of post-thrombotic syndrome (PTS) and recurrent thromboembolism, according to a systematic review and meta-analysis published in Thrombosis Research.
Canadian researchers conducted a systematic review of 62 studies with 3550 patients that had reported data on presence of PTS and UEDVT complications. They included observational studies, randomized trials, or cases series including at least 20 patients that were published after 1970.
Approximately 19% of patients with UEDVT experienced PTS and 7% experienced recurrent thrombosis. PTS was found to be more common in patients with primary (unprovoked) UEDVT compared with secondary UEDVT with a mean follow-up of 6 months, while recurrent thrombosis was more common in patients with secondary UEDVT. The researchers also found that PTS was more common in patients treated with anticoagulation alone compared with patients treated with thrombolysis or surgical decompression.
The frequency of treatment-associated major bleeding was found to be higher following an invasive treatment approach, but the researchers noted that further prospective studies are needed to better examine the association between PTS and recurrent thromboembolism with anticoagulation alone compared with thrombolysis and thoracic outlet decompression.
“The [high] morbidity associated with UEDVT in some cases may warrant consideration of a more aggressive management approach,” the researchers concluded. However, they acknowledged that no recommendation can be made to favor one treatment strategy over another on the basis of the currently available literature.
1. Thiyagarajah K, Ellingwood L, Endres K, et al. Post-thrombotic syndrome and recurrent thromboembolism in patients with upper extremity deep vein thrombosis: A systematic review and meta-analysis [published online December 7, 2018]. Thromb Res. doi: 10.1016/j.thromres.2018.12.012