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Risk Factors for Deep Venous Thrombosis of the Upper Extremities

Ida Martinelli, MD; Marco Cattaneo, MD; Daniela Panzeri, MD; Emanuela Taioli, MD, MS; and Pier Mannuccio Mannucci, MD
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From IRCCS Maggiore Hospital, University of Milan, Milan, Italy. Acknowledgments: The authors thank Drs. A. Tripodi and E.M. Faioni of the Istituto di Ricovero e Cura a Carattere Scientifico Maggiore Hospital, University of Milan, for supervising the laboratory tests used in this study. Grant Support: By the Istituto di Ricovero e Cura a Carattere Scientifico Maggiore Hospital and Angelo Bianchi Bonomi Foundation, University of Milan, Milan, Italy. Requests for Reprints: Ida Martinelli, MD, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Istituto di Ricovero e Cura a Carattere Scientifico Maggiore Hospital, University of Milan, via Pace 9, 20122 Milan, Italy. Current Author Addresses: Drs. Martinelli, Cattaneo, Panzeri, and Mannucci: Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Institute of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico Maggiore Hospital, University of Milan, via Pace 9, 20122 Milan, Italy.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1997;126(9):707-711. doi:10.7326/0003-4819-126-9-199705010-00006
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Background: Hypercoagulable states and triggering factors (surgery, trauma, immobilization, pregnancy, and use of oral contraceptives) are associated with an increased risk for deep venous thrombosis of the lower extremities. In contrast, risk factors for deep venous thrombosis of the upper extremities have not been identified.

Objective: To evaluate the prevalence of hypercoagulable states and triggering factors in patients with primary deep venous thrombosis of the upper extremities.

Design: Frequency-matched case–control study.

Setting: Hemophilia and thrombosis center at a university hospital.

Patients: 36 patients who had primary deep venous thrombosis of the upper extremities, 121 patients who had primary deep venous thrombosis of the lower extremities, and 108 healthy controls. Patients who had deep venous thrombosis of the lower extremities and study controls were frequency-matched by age, sex, geographic origin, and social status with patients who had deep venous thrombosis of the upper extremities.

Measurements: Resistance to activated protein C was evaluated by a clotting method based on the activated partial thromboplastin time. If test results were abnormal or borderline, DNA analysis for substitution in coagulation factor V gene was done. Antithrombin, protein C, protein S, antiphospholipid antibodies, and total plasma homocysteine levels were also measured.

Results: Prevalences of abnormalities of the natural anticoagulant system (9%) and hyperhomocysteinemia (6%) in patients who had deep venous thrombosis of the upper extremities were similar to prevalences of both factors in controls (6% and 7%, respectively) but lower than in patients who had deep venous thrombosis of the lower extremities (31% and 14%, respectively). Antiphospholipid antibodies were found only in patients who had venous thrombosis of the lower extremities (7%). The overall prevalence of hypercoagulable states in patients who had thrombosis of the upper extremities (15%) was similar to that in controls (12%) but was significantly lower than that in patients who had thrombosis of the lower extremities (56%). A recent history of strenuous exercise of muscles in the affected extremity was the most frequent triggering factor for patients who had deep venous thrombosis in the upper extremities (33%).

Conclusions: This preliminary study indicates that the prevalence of hypercoagulable states is low in patients who have primary deep venous thrombosis of the upper extremities.

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