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Editor's Correspondence
September 28, 1998

Upper Extremity DVT: What Is the Risk?

Arch Intern Med. 1998;158(17):1950-1952. doi:

In reply

We performed a prospective study of 58 consecutive inpatients and outpatients referred to our center because of clinically suspected venous thrombosis of the arm. Objective testing with ultrasonographic devices demonstrated the presence of venous thrombosis in almost half of them. Arm-vein thrombosis was significantly associated with the use of indwelling catheters, previous DVT of the leg, and inherited or acquired abnormalities in blood coagulation. Three patients presented with concomitant symptomatic pulmonary embolism. Results from systematic lung scans in the remaining patients revealed asymptomatic pulmonary embolism in approximately 30%. All patients with confirmed thrombosis were treated with heparin in therapeutic doses followed by oral anticoagulants (international normalized ratio, 2.0-3.0). A notable clinical improvement was observed in all patients, and bleeding did not occur in any. Long-term follow-up studies revealed 1 recurrent episode of arm-vein thrombosis complicated by fatal pulmonary embolism. Thus, the clinical characteristics of patients with arm-vein thrombosis and the long-term clinical manifestations of this disease are similar to those found in patients with venous thrombosis of the leg. Accordingly, anticoagulant therapy seems to be indicated for this condition. Our conclusions are supported by the findings of numerous studies in which patients with arm-vein thrombosis were prospectively evaluated and treated.1-4

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