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Upper extremity thromboses in medical-surgical critically ill patients

Introduction

Venous thrombosis of the upper extremity is a recognized complication of critical illness. The objective of this study was to describe the incidence and characteristics of upper-extremity thromboses in patients who were enrolled in an international trial that compared UFH versus LMWH as prophylaxis for VTE (NCT00182143).

Methods

We recorded the location, extent and prior catheterization of all patients who had upper-extremity venous thromboses confirmed by compression ultrasonography or computed tomography. No patients were routinely screened for upper-extremity thromboses. We excluded prevalent thromboses found within 72 hours of ICU admission. If a patient had both deep and superficial thromboses, we categorized as deep; if a patient had both proximal and distal thromboses, we categorized as proximal. We defined catheter-related thromboses as partial or complete noncompressibility of the same or a contiguous segment in which a catheter had been inserted within the previous 72 hours. Events were adjudicated in duplicate by physicians blinded to study drug and each others' assessments.

Results

Among 3,659 patients, 72 (2.0%) developed upper extremity thrombosis involving 129 unique venous segments. Of 72 patients, 35 (48.6%) patients had thromboses in more than one segment. Most thromboses (86, 66.7%) were on the right side. Most of these were deep (56, 77.8%), but a few were superficial (16, 22.2%). Most had proximal thromboses (65, 90.3%), but a few had distal (7, 9.7%). The three commonest sites of thrombosis were the internal jugular (29.5%), subclavian (18.6%) and cephalic (17.8%) veins. Less commonly affected were the brachial (12.4%), axillary (8.5%), basilic (8.5%), innominate (3.9%) and external jugular (0.8%) veins. Overall, 69 (53.5%) thromboses were catheter-related.

Conclusions

In medical-surgical patients who are receiving heparin prophylaxis, upper extremity DVT was uncommon, occurring in 2% of patients. These thromboses may be clinically important, because the majority is proximal and three-quarters are deep. Revisiting the need for central vascular access daily is underscored by the finding that half were catheter-related.

Acknowledgements

On behalf of the PROTECT Investigators, CCCTG and ANZICS-CTG.

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Correspondence to N Zytaruk.

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Zytaruk, N., Lamontagne, F., McIntyre, L. et al. Upper extremity thromboses in medical-surgical critically ill patients. Crit Care 15, P22 (2011). https://doi.org/10.1186/cc9442

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Keywords

  • Heparin
  • Venous Thrombosis
  • Critical Illness
  • Vascular Access
  • International Trial