Zyada Ayman, Fakhry Ayman, Nagib Sohiel, Alnadi Omar, Abouelseoud Ahmed, Seken Rahma, Jabr Muhammad
Vascular Surgery, University Hospitals of Leicester NHS Trust, Leicester, GBR.
Vascular Surgery, Egyptian Military Medical Academy, Alexandria, EGY.
Cureus. 2025 May 6;17(5):e83570. doi: 10.7759/cureus.83570. eCollection 2025 May.
Upper extremity deep vein thrombosis (UEDVT), distinct in etiology from lower limb DVT, often arises from catheter use, malignancy, or thoracic outlet syndrome. While direct oral anticoagulants (DOACs) are established for lower limb DVT, their role in UEDVT remains understudied. This meta-analysis evaluates the efficacy and safety of DOACs compared to low-molecular-weight heparin (LMWH) in UEDVT. A systematic PubMed search identified nine studies (643 DOAC-treated patients). Outcomes included mortality, venous thromboembolism (VTE) recurrence, pulmonary embolism (PE), and major bleeding. DOACs demonstrated significantly lower mortality (2.49% vs. 16.5-27.5%; p<0.001), VTE recurrence (0.93% vs. 5%; p<0.001), and PE incidence (0.31% vs. 5-8%; p<0.001) compared to historical LMWH data. However, major bleeding rates were higher with DOACs (2.02% vs. 0.25%; p<0.001). Patient cohorts predominantly had cancer-related (66.7%) or catheter-associated (64.5%) UEDVT, with rivaroxaban being the most used DOAC (70.9%). Median treatment duration was three months, with a six-month follow-up. These findings suggest DOACs may offer superior efficacy in reducing mortality and thrombotic complications in UEDVT, though with an increased bleeding risk. Limitations include reliance on historical LMWH comparisons, heterogeneity in study designs, and small event counts for PE. Standardized imaging and extended follow-up are needed to assess long-term outcomes. While DOACs present a promising alternative, cautious use in high-bleeding-risk patients is warranted. Further randomized trials are essential to validate these results and refine clinical guidelines.
上肢深静脉血栓形成（UEDVT）在病因上与下肢深静脉血栓形成不同，通常由导管使用、恶性肿瘤或胸廓出口综合征引起。虽然直接口服抗凝剂（DOACs）已被确立用于治疗下肢深静脉血栓形成，但其在UEDVT中的作用仍研究不足。本荟萃分析评估了DOACs与低分子肝素（LMWH）相比在UEDVT治疗中的疗效和安全性。通过对PubMed进行系统检索，确定了9项研究（643例接受DOAC治疗的患者）。结局指标包括死亡率、静脉血栓栓塞（VTE）复发、肺栓塞（PE）和大出血。与历史LMWH数据相比，DOACs的死亡率（2.49%对16.5 - 27.5%；p<0.001）、VTE复发率（0.93%对5%；p<0.001）和PE发生率（0.31%对5 - 8%；p<0.001）显著更低。然而，DOACs的大出血发生率更高（2.02%对0.25%；p<0.001）。患者队列主要为癌症相关（66.7%）或导管相关（64.5%）的UEDVT，利伐沙班是最常用的DOAC（70.9%）。中位治疗持续时间为3个月，随访6个月。这些发现表明，DOACs在降低UEDVT的死亡率和血栓形成并发症方面可能具有更好的疗效，尽管出血风险增加。局限性包括依赖历史LMWH比较、研究设计的异质性以及PE事件数量较少。需要标准化成像和延长随访来评估长期结局。虽然DOACs是一种有前景的替代药物，但对于高出血风险患者应谨慎使用。进一步的随机试验对于验证这些结果和完善临床指南至关重要。
