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Journal of thrombosis and haemostasis : JTH
03, 2022;20 (3): 661-670.

Anticoagulant treatment for upper extremity deep vein thrombosis: A systematic review and meta-analysis.

Emanuele Valeriani, Marcello Di Nisio, Enrica Porceddu, Fabiana Agostini, Roberto Pola, Silvia Spoto, Marco Paolo Donadini, Walter Ageno, Angelo Porfidia
Author Information
  1. Emanuele Valeriani: Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy. ORCID
  2. Marcello Di Nisio: Department of Medicine and Ageing Sciences, University "G. d'Annunzio" of Chieti-Pescara, Chieti, Italy. ORCID
  3. Enrica Porceddu: Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy.
  4. Fabiana Agostini: Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy.
  5. Roberto Pola: Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy. ORCID
  6. Silvia Spoto: Diagnostic and Therapeutic Medicine Department, University Campus Bio-Medico of Rome, Rome, Italy.
  7. Marco Paolo Donadini: Department of Clinical Medicine, University of Insubria, Varese, Italy.
  8. Walter Ageno: Department of Clinical Medicine, University of Insubria, Varese, Italy.
  9. Angelo Porfidia: Department of Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore School of Medicine, Rome, Italy. ORCID
PMID: 34846783 DOI: 10.1111/jth.15614

Abstract

BACKGROUND: Data on anticoagulant treatment for upper extremity deep vein thrombosis (UEDVT) are largely derived from studies on usual site venous thromboembolism (VTE).
OBJECTIVES: The objective of this meta-analysis was to evaluate the efficacy and safety of anticoagulant therapy for UEDVT.
PATIENTS/METHODS: A systematic search of MEDLINE and EMBASE was conducted for studies including patients with UEDVT. Primary outcomes were recurrent VTE and major bleeding. Secondary outcomes included clinically-relevant non-major bleeding and all-cause mortality. Summary estimates with 95% confidence intervals (CIs) were calculated by random-effect meta-analysis.
RESULTS: A total of 1473 patients from 11 prospective and nine retrospective studies were included. Sixty percent of patients had an indwelling catheter and 56.1% had cancer. Anticoagulant treatment consisted of direct oral anticoagulants, low molecular weight heparin followed by vitamin K antagonists, and low molecular weight heparin alone in 45.1%, 35.0%, and 19.9% of patients, respectively. During a median follow-up of 13 months, recurrent VTE occurred in 3% of patients (95% CI: 2-4; 21/1334 patients), major bleeding in 3% (95% CI: 2%-5%; 29/1235 patients), clinically-relevant non-major bleeding in 4% (95% CI: 3-6; 40/1075 patients), and all-cause mortality in 9% (95% CI: 5-15; 108/1084 patients). Rates of these outcomes were not significantly different between patients with or without cancer, patients with or without an indwelling catheter, and among those receiving different anticoagulant treatments.
CONCLUSIONS: In patients with UEDVT, anticoagulant treatment is associated with a low risk of recurrent VTE and a nonnegligible risk of major bleeding.

Keywords

anticoagulants direct-acting oral anticoagulant low molecular weight heparin upper extremity deep vein thrombosis venous thromboembolism

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MeSH Term

Anticoagulants
Heparin, Low-Molecular-Weight
Humans
Prospective Studies
Retrospective Studies
Upper Extremity Deep Vein Thrombosis
Venous Thromboembolism

Chemicals

Anticoagulants
Heparin, Low-Molecular-Weight
Journal Article Meta-Analysis Systematic Review

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