From the Department of Internal Medicine.
Department of Quantitative Health Sciences.
South Med J. 2024 Sep;117(9):534-538. doi: 10.14423/SMJ.0000000000001728.
Upper extremity deep vein thrombosis (UEDVT) is associated with pulmonary embolism and other complications, but there are no recommendations for UEDVT prophylaxis. The purpose of this study was to establish incidence and risk factors for UEDVT and to determine efficacy of pharmacologic prophylaxis for UEDVT prevention.
For this retrospective cohort study, we identified medical patients aged 18 years and older admitted to 13 Cleveland Clinic hospitals from January 2011 to December 2019. Patients with venous thromboembolism (VTE) on admission, length of stay <1 day, and who received therapeutic anticoagulation were excluded. The potential risk factors included demographics, comorbidities, and medical procedures. Comorbidities were identified via codes, (ICD9 and ICD10), procedures from flowsheets, and prophylaxis from medications administered in the electronic medical record. DVT events were identified by a combination of codes and confirmed by chart review. We performed multivariable logistic regression to identify independent risk factors and the association between VTE prophylaxis and UEDVT. The model's C statistic was obtained using 1000 bootstrap runs.
Of 194,809 patients, 496 (0.25% of cohort, 36.8% of all VTE) developed UEDVT by 14 days. In the logistic regression model (bias-corrected C statistic 0.87), 11 risk factors predicted UEDVT, the strongest being peripherally inserted central catheter (odds ratio [OR] 4.62, 95% confidence interval [CI] 3.81-5.60) and central venous catheter (OR 3.57, 95% CI 2.91-4.37). The predicted risk among individuals ranged from 0.02% to 23.4%. Prophylaxis was negatively associated with the development of UEDVT (OR 0.72, 95% CI 0.60-0.87).
UEDVT is rare but some patients are high risk. Therefore, UEDVT risk factors should be added to VTE risk assessment models, and patients at high risk for UEDVT should receive chemoprophylaxis.
上肢深静脉血栓形成（UEDVT）与肺栓塞和其他并发症有关，但目前尚无 UEDVT 预防的建议。本研究旨在确定 UEDVT 的发生率和危险因素，并确定药物预防 UEDVT 的疗效。
本回顾性队列研究纳入了 2011 年 1 月至 2019 年 12 月期间在克利夫兰诊所的 13 家医院住院的年龄在 18 岁及以上的成年患者。排除入院时患有静脉血栓栓塞症（VTE）、住院时间<1 天和接受治疗性抗凝治疗的患者。潜在的危险因素包括人口统计学、合并症和医疗程序。合并症通过代码（ICD9 和 ICD10）、流程表中的程序和电子病历中给予的药物预防来确定。通过组合代码和图表审查来确定 DVT 事件。我们进行了多变量逻辑回归分析，以确定独立的危险因素以及 VTE 预防与 UEDVT 之间的关联。该模型的 C 统计量通过 1000 次自举运行获得。
在 194809 名患者中，有 496 名（队列的 0.25%，所有 VTE 的 36.8%）在 14 天内发生了 UEDVT。在逻辑回归模型中（经偏倚校正的 C 统计量为 0.87），有 11 个危险因素预测了 UEDVT，最强的是外周插入中心导管（比值比 [OR] 4.62，95%置信区间 [CI] 3.81-5.60）和中心静脉导管（OR 3.57，95% CI 2.91-4.37）。个体的预测风险范围从 0.02%到 23.4%。预防与 UEDVT 的发生呈负相关（OR 0.72，95% CI 0.60-0.87）。
UEDVT 虽然罕见，但部分患者风险较高。因此，应将 UEDVT 危险因素添加到 VTE 风险评估模型中，并且高危 UEDVT 患者应接受化学预防。
