Department of Medicine, Division of Hematology and Thromboembolism, McMaster University, Hamilton, ON, Canada; Ministry Of Health, AL Khuwair, Oman.
Department of Medicine, McMaster University, Hamilton, ON, Canada; Medicine, Chiang Mai University, Chiang Mai, Thailand.
Thromb Res. 2018 Jun;166:92-95. doi: 10.1016/j.thromres.2018.03.020. Epub 2018 Apr 3.
Data on management of upper extremity deep vein thrombosis (UEDVT) in patients with cancer is limited. The objective of this study was to determine risk factors for UEDVT and the rates of recurrence and bleeding in a real-world setting.
Retrospective review of consecutive patients assessed for cancer-associated UEDVT. Outcome measures were recurrent venous thromboembolism (VTE), and major and clinically relevant non-major bleeding (CRNMB). Risk factors for recurrent VTE and bleeding were assessed.
Mean duration of follow-up was 7.2 months. Two hundred cases were identified; 69% were associated with a central line. Non-line associated UEDVT occurred more frequently in the setting of breast cancer, lung cancer and documented local mass effect. The incidence of recurrent VTE was 18.5%, of which 14 (37.8%) were ipsilateral UEDVT. The risk of recurrence is higher with male gender (HR 2.0, 95% CI; 1.0-4.0). Major and CRNMB occurred in 1% and 11.5%, respectively. Concurrent use of an antiplatelet agent was associated with a higher risk of CRNMB compared to anticoagulant therapy alone (HR 3.9, 95% CI; 1.4-10.7).
Presence of a venous catheter was the primary risk factor for UEDVT, however, extrinsic compression by local tumour may be just as important for some cancer types. Furthermore, the majority of recurrent events did not occur in the same upper limb suggesting that UEDVT may be predictive of increased thrombotic risk rather than just a local effect of catheters.
有关癌症患者上肢深静脉血栓形成（UEDVT）的管理数据有限。本研究的目的是确定真实环境下 UEDVT 的危险因素以及复发和出血的发生率。
回顾性分析连续评估的癌症相关 UEDVT 患者。主要终点是复发性静脉血栓栓塞症（VTE），次要终点是大出血和临床相关非大出血（CRNMB）。评估了复发 VTE 和出血的危险因素。
中位随访时间为 7.2 个月。共发现 200 例病例，其中 69%与中心静脉导管相关。非导管相关 UEDVT 更常见于乳腺癌、肺癌和有记录的局部肿块效应的患者。复发 VTE 的发生率为 18.5%，其中 14 例（37.8%）为同侧 UEDVT。男性的复发风险更高（HR 2.0，95%CI：1.0-4.0）。大出血和 CRNMB 的发生率分别为 1%和 11.5%。与单独抗凝治疗相比，同时使用抗血小板药物与更高的 CRNMB 风险相关（HR 3.9，95%CI：1.4-10.7）。
静脉导管的存在是 UEDVT 的主要危险因素，但局部肿瘤的外在压迫对于某些癌症类型可能同样重要。此外，大多数复发事件并未发生在上肢相同部位，这表明 UEDVT 可能预示着血栓形成风险增加，而不仅仅是导管的局部作用。
