Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study

Olivier Espitia; Audry Tissot; Annaïg Miossec; Marc-Antoine Pistorius; Rodica Richard; Alizée Raimbeau; Antoine Bénichou; Benjamin Espinasse; Alexis F Guédon

doi:10.1016/j.thromres.2023.11.026

Upper extremity venous thrombosis in hospitalized patients: A prospective epidemiological study

Thromb Res. 2024 Jan:233:174-180. doi: 10.1016/j.thromres.2023.11.026. Epub 2023 Nov 29.

Authors

Olivier Espitia¹, Audry Tissot², Annaïg Miossec², Marc-Antoine Pistorius², Rodica Richard², Alizée Raimbeau², Antoine Bénichou², Benjamin Espinasse³, Alexis F Guédon²

Affiliations

¹ Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France; Nantes Université, l'institut du thorax, INSERM UMR1087/CNRS UMR 6291, Team III Vascular & Pulmonary Diseases, F-44000 Nantes, France. Electronic address: olivier.espitia@chu-nantes.fr.
² Nantes Université, CHU Nantes, Department of Internal and Vascular Medicine, F-44000 Nantes, France.
³ GETBO INSERM 1304 & Department of Vascular Medicine, CHU Brest, F-29000 Brest, France.

PMID: 38091816
DOI: 10.1016/j.thromres.2023.11.026

Abstract

Background: The frequency of upper extremities vein thrombosis (UEVT) is rising with the increasing use of endovenous devices. These thromboses are particularly common among hospitalized patients. The epidemiology and risk factors for UEVT are poorly understood in a hospitalized population.

Objective: To assess the prevalence of UEVT in hospitalized patients and study thrombosis risk factors according to their location.

Methods: Prospective evaluation of patients hospitalized in a university hospital with clinical and Doppler ultrasound (DUS) assessment of the upper extremities.

Results: Of the 400 patients included, 91(22.8 %) had UEVT including 8 (8.8 %) proximal thrombosis, 32 (35.2 %) arm venous thrombosis and 51 (56.0 %) forearm venous thrombosis; 7 (7.7 %) patients with UEVT had a concomitant symptomatic pulmonary embolism. In this population of hospitalized patients, 40 (10 %) had proximal or arm thrombosis and 51 (12.8 %) forearm thrombosis. All patients with UEVT had a venous catheter and 63 (69.2 %) of UEVT patients had therapeutic or prophylactic anticoagulation at the time of DUS evaluation. In multivariate analysis, peripheral intravenous catheter (PIVC) OR 3.71 [1.90; 7.91] (p < 0.001); MID line OR 3.58 [1.46; 8.91] (p = 0.005) and infection disease OR 2.21 [1.26; 4386] (p = 0.005) were associated with UEVT. Central venous catheter OR 66.24 [12.64; 587.03] was associated with proximal UEVT and MID line OR 12.61 [4.64; 35.77] (p < 0.001) with arm UEVT. Forearm UEVT were associated with PIVCOR 10.71[3.14; 67.37] (p = 0.001); infectious disease OR 2.87 [1.48; 5.60] (p = 0.002), iron infusion OR 3.11 [1.23; 7.47] and hospitalization for postpartum OR 4.37 [0.97; 18.06] (p = 0.04).

Conclusion: One in 5 hospitalized patients suffers from UEVT. Proximal venous thrombosis is uncommon. The presence of a catheter and hospitalization for infection are the factors most frequently associated with UEVT.

Keywords: Central catheter; Hospitalized patients; PICC line; Upper extremity vein thrombosis.

MeSH terms

Catheterization, Central Venous* / adverse effects
Female
Humans
Retrospective Studies
Risk Factors
Upper Extremity
Upper Extremity Deep Vein Thrombosis* / epidemiology
Upper Extremity Deep Vein Thrombosis* / etiology
Upper Extremity Deep Vein Thrombosis* / therapy
Venous Thrombosis* / etiology