Upper Extremity Deep Vein Thrombosis: Incidence, Risk Factors, and Effectiveness of Chemoprophylaxis.

IF 1 4区医学 Q3 MEDICINE, GENERAL & INTERNAL

Southern Medical Journal Pub Date : 2024-09-01 DOI:10.14423/SMJ.0000000000001728

Caroline K Olt, Bo Hu, Michael B Rothberg

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引用次数: 0

Abstract

Objectives: 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.

Methods: 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 International Classification of Diseases 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 International Classification of Diseases 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.

Results: 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).

Conclusions: 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.

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上肢深静脉血栓：发病率、风险因素和化学预防的效果。

目的：上肢深静脉血栓形成（UEDVT）与肺栓塞和其他并发症有关，但目前尚无预防 UEDVT 的建议。本研究旨在确定 UEDVT 的发病率和风险因素，并确定药物预防 UEDVT 的疗效：在这项回顾性队列研究中，我们确定了 2011 年 1 月至 2019 年 12 月期间克利夫兰诊所 13 家医院收治的 18 岁及以上内科患者。入院时患有静脉血栓栓塞症（VTE）的患者、住院时间国际疾病分类代码（ICD9 和 ICD10）、流程表中的手术和电子病历中的预防用药。深静脉血栓事件通过国际疾病分类代码组合进行识别，并通过病历审查进行确认。我们进行了多变量逻辑回归，以确定独立的风险因素以及 VTE 预防与 UEDVT 之间的关联。该模型的 C 统计量是通过 1000 次引导运行得出的：在 194 809 例患者中，有 496 例（占队列的 0.25%，占所有 VTE 的 36.8%）在 14 天前发生了 UEDVT。在逻辑回归模型中（偏差校正 C 统计量为 0.87），有 11 个风险因素可预测 UEDVT，其中最强的是外周置入中心导管（比值比 [OR] 4.62，95% 置信区间 [CI] 3.81-5.60）和中心静脉导管（比值比 3.57，95% 置信区间 2.91-4.37）。个人预测风险从 0.02% 到 23.4% 不等。预防与 UEDVT 的发生呈负相关（OR 0.72，95% CI 0.60-0.87）：结论：UEDVT虽然罕见，但部分患者属于高危人群。因此，应在 VTE 风险评估模型中加入 UEDVT 风险因素，UEDVT 高危患者应接受化学预防。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Southern Medical Journal 医学-医学：内科

CiteScore

1.40

自引率

9.10%

发文量

222

审稿时长

4-8 weeks

期刊介绍： As the official journal of the Birmingham, Alabama-based Southern Medical Association (SMA), the Southern Medical Journal (SMJ) has for more than 100 years provided the latest clinical information in areas that affect patients'' daily lives. Now delivered to individuals exclusively online, the SMJ has a multidisciplinary focus that covers a broad range of topics relevant to physicians and other healthcare specialists in all relevant aspects of the profession, including medicine and medical specialties, surgery and surgery specialties; child and maternal health; mental health; emergency and disaster medicine; public health and environmental medicine; bioethics and medical education; and quality health care, patient safety, and best practices. Each month, articles span the spectrum of medical topics, providing timely, up-to-the-minute information for both primary care physicians and specialists. Contributors include leaders in the healthcare field from across the country and around the world. The SMJ enables physicians to provide the best possible care to patients in this age of rapidly changing modern medicine.