Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry
Aim: The aim of the study is to up date informations on the clinical characteristics and outcome of patients with upper-extremity deep vein thrombosis (DVT) from the Informatised Registry on Venous Thromboembolism (RIETE). Methods: RIETE is an ongoing registry of consecutive patients with symptomati...
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Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України
2006
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| Цитувати: | Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry / M. Monreal, F.J. Munoz, V. Rosa, C. Romero, P. Roman, P. Di Micco, P. Prandoni // Experimental Oncology. — 2006. — Т. 28, № 3. — С. 245-247. — Бібліогр.: 14 назв. — англ. |
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irk-123456789-1375692018-06-18T03:06:35Z Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry Monreal, M. Munoz, F.J. Rosa, V. Romero, C. Roman, P. Di Micco, P. Prandoni, P. Short communications Aim: The aim of the study is to up date informations on the clinical characteristics and outcome of patients with upper-extremity deep vein thrombosis (DVT) from the Informatised Registry on Venous Thromboembolism (RIETE). Methods: RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism. In this analysis the clinical characteristics and 3-month outcome of all cancer patients with upper-extremity DVT were evaluated. Results: Up to February 2006, a total of 14,391 patients with symptomatic, objectively confirmed acute venous thromboembolism had been enrolled in RIETE. Of the 2,945 patients with active cancer 196 (6.7%) had arm DVT: 104 had catheter-associated DVT. Most cancer patients with arm DVT were males, younger than 65, and had a low incidence of additional risk factors or underlying diseases. Twenty of them (10%) had symptomatic pulmonary embolism (PE). Most patients were treated with low-molecular-weigh heparin, both initially (94%) and after discharge (75%). During the 3-month follow-up period 12 patients (6.1%) developed VTE recurrences (PE 6, DVT 6), 8 (4.1%) had major bleeding (fatal in 3), 43 (22%) died. Conclusions: Our data from the RIETE registry show that upper limb DVT is a serious complication in patients with cancer, with a high incidence of recurrences and bleeding complications. Цель: обновить базу данных по клиническим характеристикам и течению заболевания у больных с тромбозом глубоких вен верхних конечностей (ТГВ) с использованием системы регистра венозного тромбоэмболизма (СРВТ). Методы: СРВТ является непрерывной системой регистрации больных с симптомами объективно подтвержденной острой венозной тромбоэмболии. Проанализированы клинические характеристики и течение болезни на протяжении месяцев у больных онкологического профиля с ТГВ. Результаты: в период декабря 2006 г. были обследованы 14 391 больных с симптоматической объективно подтвержденной острой венозной тромбоэмболией при помощи системы СРВТ. Из 2945 больных с прогрессирующим течением заболевания у196 (6,7%) человек выявили ТГВ верхних конечностей: у 104 — ассоциированный с катетером ТГВ. Большинство больных с ТГВ верхних конечностей — лица мужского пола в возрасте моложе 65 лет и с низкой частотой дополнительных факторов риска или первичного заболевания. У 20 из них (10%) отмечали симптомы эмболии легочной артерии (ЭЛА). Больные получали низкомолекулярный гепарин и в начале исследования (94%), и по его окончании (75%). В течение последующих трех месяцев у12 больных (6,1%) развился рецидив венозной тромбоэмболии (ВТЭ) (ЭЛА – у 6 больных, ТГВ – у 6 больных), у 8 (4,1%) отмечали кровотечение (3 случая с летальным исходом), 43 (22%) пациента умерли. Выводы: данные СРВТ системы показали, что ТГВ верхних конечностей является серьезным осложнением у больных, онкологического профиля, сочетающимся с высокой степенью развития рецидива и осложнений, сопровождающихся кровотечениями. 2006 Article Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry / M. Monreal, F.J. Munoz, V. Rosa, C. Romero, P. Roman, P. Di Micco, P. Prandoni // Experimental Oncology. — 2006. — Т. 28, № 3. — С. 245-247. — Бібліогр.: 14 назв. — англ. 1812-9269 http://dspace.nbuv.gov.ua/handle/123456789/137569 en Experimental Oncology Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
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Short communications Short communications |
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Short communications Short communications Monreal, M. Munoz, F.J. Rosa, V. Romero, C. Roman, P. Di Micco, P. Prandoni, P. Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry Experimental Oncology |
| description |
Aim: The aim of the study is to up date informations on the clinical characteristics and outcome of patients with upper-extremity deep vein thrombosis (DVT) from the Informatised Registry on Venous Thromboembolism (RIETE). Methods: RIETE is an ongoing registry of consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism. In this analysis the clinical characteristics and 3-month outcome of all cancer patients with upper-extremity DVT were evaluated. Results: Up to February 2006, a total of 14,391 patients with symptomatic, objectively confirmed acute venous thromboembolism had been enrolled in RIETE. Of the 2,945 patients with active cancer 196 (6.7%) had arm DVT: 104 had catheter-associated DVT. Most cancer patients with arm DVT were males, younger than 65, and had a low incidence of additional risk factors or underlying diseases. Twenty of them (10%) had symptomatic pulmonary embolism (PE). Most patients were treated with low-molecular-weigh heparin, both initially (94%) and after discharge (75%). During the 3-month follow-up period 12 patients (6.1%) developed VTE recurrences (PE 6, DVT 6), 8 (4.1%) had major bleeding (fatal in 3), 43 (22%) died. Conclusions: Our data from the RIETE registry show that upper limb DVT is a serious complication in patients with cancer, with a high incidence of recurrences and bleeding complications. |
| format |
Article |
| author |
Monreal, M. Munoz, F.J. Rosa, V. Romero, C. Roman, P. Di Micco, P. Prandoni, P. |
| author_facet |
Monreal, M. Munoz, F.J. Rosa, V. Romero, C. Roman, P. Di Micco, P. Prandoni, P. |
| author_sort |
Monreal, M. |
| title |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry |
| title_short |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry |
| title_full |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry |
| title_fullStr |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry |
| title_full_unstemmed |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry |
| title_sort |
upper extremity dvt in oncological patients: analysis of risk factors. data from the riete registry |
| publisher |
Інститут експериментальної патології, онкології і радіобіології ім. Р.Є. Кавецького НАН України |
| publishDate |
2006 |
| topic_facet |
Short communications |
| url |
http://dspace.nbuv.gov.ua/handle/123456789/137569 |
| citation_txt |
Upper extremity dvt in oncological patients: analysis of risk factors. Data from the RIETE registry / M. Monreal, F.J. Munoz, V. Rosa, C. Romero, P. Roman, P. Di Micco, P. Prandoni // Experimental Oncology. — 2006. — Т. 28, № 3. — С. 245-247. — Бібліогр.: 14 назв. — англ. |
| series |
Experimental Oncology |
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2025-07-10T02:36:05Z |
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2025-07-10T02:36:05Z |
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1837225704132968448 |
| fulltext |
Experimental Oncology 28, 245–247, 2006 (September) 245
Patients with cancer are more prone to develop venous
thromboembolism (VTE), due to the hypercoagulable
state caused by the malignancy, but also to other additive
risk factors, such as mechanical injury of the venous endo
thelium by the use of intravenous catheters and irritation
of vessel walls by chemotherapy. In cancer patients who
develop VTE the risk of death is more than threefold than in
patients without cancer who have VTE [1–3] and in those
with cancer but no VTE [4]. This high mortality rate is pro
bably due to both the VTE and the fact that malignancies
associated with VTE appear to follow a more aggressive
course [4]. Thus, identifying clinical characteristics that
put cancer patients at increased risk of VTE is important
if their outcomes are to be improved.
Upperextremity deep vein thrombosis (DVT) was
long believed to be an uncommon disorder caused by
malrotation of the upper extremity, especially when as
sociated with strenuous exercise. However, with the in
creasingly common use of intravenous catheters, arm
DVT has been recognised as being more common than
previously reported, but its frequency continues to be
much lower than that of lower limb DVT. Accordingly,
there is little information on the clinical characteristics
and outcome of these patients.
The Informatised Registry on Venous Thromboem
bolism (RIETE) was initiated in March 2001 to prospec
tively record the current clinical management of VTE.
It is an ongoing, multicenter, observational registry
designed to gather and analyze data on treatment
patterns and clinical outcomes in consecutive patients
with symptomatic, objectively confirmed, acute VTE
[5–9]. The aim of the present study was to identify
the clinical characteristics and 3month outcome of
all cancer patients with upperextremity deep venous
thrombosis (DVT) enrolled in RIETE.
Patients and Methods
Consecutive patients with symptomatic, acute DVT
or pulmonary embolism (PE), confirmed by objective
tests are enrolled in RIETE.
Variables. The parameters recorded by the registry
comprise details of each patient’s baseline characteris
tics; clinical status, including any coexisting or underlying
conditions; cancer characteristics; the type, dose, and
duration of treatment received on VTE diagnosis, and
clinical outcome during the first 3 months of therapy.
Clinical definitions. Immobilized patients are de
fined in this analysis as nonsurgical patients who had
been immobilized (i. e., total bed rest with bathroom
privileges) for ≥ 4 days in the 2month period prior to
VTE diagnosis. Surgical patients are defined as those
who had undergone an operation in the 2 months prior
to VTE diagnosis. Fatal PE was defined as any death
occurring shortly (< 7 days) after PE diagnosis (either
the initial episode or recurrent PE), in the absence of an
alternative cause of death. Fatal bleeding was defined
UPPer extreMity dVt in oncological Patients: analysis
of risk factors. data froM the riete registry
M. Monreal1, *, F.J. Munoz2, V. Rosa3, C. Romero4, P. Roman5, P. Di Micco6, P. Prandoni7
1Internal Medicine Division, Hospital of Germans Trias i Pujol University, Badalona, Spain
2Internal Medicine Division, Hospital de Mollet, Barcelona, Spain
3Internal Medicine Division, Hospital Vega Baja, Orihuela, Alicante, Spain
4Internal Medicine Division, Hospital Costa del Sol, Marbella, Málaga, Spain
5Internal Medicine Division, General Hospital of Requena, Requena, Valencia, Spain
6Internal Medicine Division, Buonconsiglio Fatebenefratelli Hospital, Naples, Italy
7Medical and Surgical Science, Medical Clinic II, University of Padova, Padova, Italy
Aim: The aim of the study is to up date informations on the clinical characteristics and outcome of patients with upper-extremity
deep vein thrombosis (DVT) from the Informatised Registry on Venous Thromboembolism (RIETE). Methods: RIETE is an ongoing
registry of consecutive patients with symptomatic, objectively confirmed, acute venous thromboembolism. In this analysis the clinical
characteristics and 3-month outcome of all cancer patients with upper-extremity DVT were evaluated. Results: Up to February 2006,
a total of 14,391 patients with symptomatic, objectively confirmed acute venous thromboembolism had been enrolled in RIETE. Of
the 2,945 patients with active cancer 196 (6.7%) had arm DVT: 104 had catheter-associated DVT. Most cancer patients with arm
DVT were males, younger than 65, and had a low incidence of additional risk factors or underlying diseases. Twenty of them (10%)
had symptomatic pulmonary embolism (PE). Most patients were treated with low-molecular-weigh heparin, both initially (94%)
and after discharge (75%). During the 3-month follow-up period 12 patients (6.1%) developed VTE recurrences (PE 6, DVT 6),
8 (4.1%) had major bleeding (fatal in 3), 43 (22%) died. Conclusions: Our data from the RIETE registry show that upper limb DVT
is a serious complication in patients with cancer, with a high incidence of recurrences and bleeding complications.
Key Words: cancer, catheter, vein, thrombosis, risk factor.
Recieved: June 26, 2006.
*Correspondence: Fax: 34 934978843
E-mail: mmonreal.germanstrias@gencat.net
Abbreviations used: AVK — anti-vitamin K; CI — confidence intervals;
DVT — deep vein thrombosis; LMWH — low-molecular-weight heparin;
PE — pulmonary embolism; RIETE — Informatised Registry on Venous
Thromboembolism; UFH — unfractionated heparin; VTE — venous
thromboembolism.
Exp Oncol 2006
28, 3, 245–247
short coMMUnications
246 Experimental Oncology 28, 245–247, 2006 (September)
as any death occurring shortly (< 7 days) after a major
bleeding episode. Bleeding complications were classi
fied as “major” if they were overt and were associated
with a decrease in hemoglobin level of ≥ 2.0 g/dL,
required a transfusion of ≥ 2 units of blood, or were
retroperitoneal or intracranial.
Follow-up. After hospital discharge, all patients
were followedup for at least 3 months. During each
visit, any signs or symptoms suggesting either DVT or
PE recurrence or bleeding complications were noted.
Each episode of clinically suspected recurrent DVT or
PE was documented by repeat compression ultraso
nography, venography, lung scanning, helical CT scan
or pulmonary angiography.
Statistical analysis. Odds ratios and corresponding
95% confidence intervals were calculated using Con
fidence Interval Analysis software (version 2.0.0), and
p < 0.05 was considered to be statistically significant. The
significance of a number of clinical variables on the mor
tality rate was tested by ChiSquare test for categorical
variables and by ttest for numerical variables. Candidate
variables were selected from clinical variables based on
published literature and on expert opinion.
resUlts
Up to Febrary 2006, a total of 14,391 patients with
symptomatic, objectively confirmed acute VTE had been
enrolled in RIETE and followedup for up to 3 months.
Of the 2,945 patients with active cancer 196 (6.7%)
had arm DVT. One hundred and four of them (53%) had
catheterassociated DVT (central line 37, port system
37, peripheral line 8, stent 6, pacemaker one).
Most cancer patients with arm DVT were males,
younger than 65, and had a low incidence of additional
risk factors or underlying diseases. Twenty of these
patients (10%) had both clinical signs and objective
diagnosis of PE. Most patients were treated with low
molecularweigh heparin, both initially (94%) and after
discharge (75%). During the 3month followup period
12 patients (6.1%) developed VTE recurrences (PE 6,
DVT 6), 8 (4.1%) had major bleeding (fatal in 3).
Patients with catheterassociated DVT had more of
ten a recent episode of surgery, and less often chronic
lung disease than those with no catheter, as shown in
the Table. Rightside DVT was more common in these
patients. They had less often metastatic cancer, and
appeared more commonly in patients with colorectal
cancer, but less often in lung cancer. During followup,
the rates of fatal PE, recurrent VTE, fatal bleeding and
major bleeding were similar, but overall death was
higher in patients with no catheter.
discUssion
The data in this analysis, obtained from a large pro
spective series of consecutively enrolled patients in the
RIETE registry, confirm that arm DVT is an uncommon
complication in patients with cancer compared to lower
extremity DVT. There was a similar incidence in patients
with or without catheter, and one in every 10 patients
had concomitant PE. As for their clinical outcome, the
6.1% incidence of recurrences and the 4.1% of major
bleeding is similar to the reported rates in patients with
lower limb DVT while on anticoagulation [10].
Table. Clinical characteristics and 3-month outcome of the 196 patients
with cancer and upper-extremity DVT
Variables
Cathe
ter
N = 104
No
catheter
N = 92
Odds ratio
(95% CI)
P
value
Clinical characteristics,
Gender (males)
Age > 65 years
Body weight < 70 kg
Underlying diseases,
Creatinine levels > 1.2 mg/dL
Chronic lung disease
Chronic heart failure
Risk factors for VTE,
Immobility ≥ 4 days
Surgery < 2 months
Prior VTE
Cancer characteristics,
Metastatic cancer
Site of cancer:
Lung
Breast
Colorectal
Stomach
Haematological
Other
Clinical presentation,
Symptomatic PE
Left side DVT
Bilateral DVT
Initial therapy,
UFH
LMWH
Long-term therapy,
AVK drugs
LMWH
3-month outcome,
Major bleeding
Fatal bleeding
Recurrent DVT
Recurrent PE
Fatal PE
Overall mortality
59 (57%)
39 (38%)
54 (52%)
11 (11%)
4 (3.8%)
2 (1.9%)
5 (4.8%)
29 (28%)
5 (4.8%)
51 (49%)
23 (22%)
13 (13%)
23 (22%)
11 (11%)
10 (9.6%)
24 (23%)
10 (9.6%)
35 (34%)
5 (4.8%)
3 (2.9%)
98 (94%)
23 (22%)
75 (72%)
4 (3.8%)
1 (1.0%)
4 (3.8%)
4 (3.8%)
1 (1.0%)
17 (16%)
63 (69%)
39 (42%)
46 (50%)
5 (5.4%)
12 (13%)
6 (6.5%)
8 (8.7%)
12 (13%)
8 (8.7%)
58 (63%)
32 (35%)
14 (15%)
5 (5.4%)
4 (4.3%)
5 (5.4%)
32 (35%)
10 (11%)
45 (50%)
10 (11%)
5 (5.4%)
87 (95%)
22 (24%)
63 (68%)
4 (4.3%)
2 (2.2%)
2 (2.2%)
2 (2.2%)
0
26 (28%)
0.6 (0.3–1.1)
0.8 (0.5–1.4)
1.1 (0.6–1.9)
2.1 (0.7–6.2)
0.3 (0.1–0.9)
0.3 (0.1–1.4)
0.5 (0.2–1.7)
2.6 (1.2–5.4)
0.5 (0.2–1.7)
0.6 (0.3–1.0)
0.5 (0.3–1.0)
0.8 (0.4–1.8)
4.9 (1.8–14)
2.6 (0.8–8.5)
1.6 (0.6–5.6)
0.6 (0.3–1.1)
0.9 (0.3–2.4)
0.5 (0.3–1.0)
0.4 (0.1–1.4)
0.5 (0.1–2.6)
0.9 (0.2–3.6)
0.9 (0.4–1.8)
1.2 (0.6–2.3)
0.9 (0.2–3.6)
0.4 (0.1–4.9)
1.8 (0.3–10)
1.8 (0.3–10)
—
0.5 (0.2–1.0)
0.090
0.485
0.788
0.189
0.019
0.104
0.275
0.011
0.275
0.049
0.050
0.582
0.001
0.102
0.272
0.070
0.773
0.030
0.112
0.369
0.919
0.765
0.578
0.859
0.490
0.498
0.498
0.346
0.044
Traditionally, the significance of arm DVT has
received less attention in comparison to lower extre
mities DVT, probably due to the erroneous belief that
accompanying or subsequent PE is rare. Accordingly,
in the past several authors have questioned the need
for anticoagulant therapy in such patients. However,
recent prospective studies using sensitive methods for
detecting PE have demonstrated that the prevalence
of both symptomatic and asymptomatic PE in patients
with arm DVT is high, and it is close to that observed in
cohorts of patients with lowerextremity DVT [11–14].
One in every ten patients with arm DVT in our series had
symptomatic PE, thus confirming these findings.
The main limitation of this study lies on the likely un
derestimated incidence rate of fatal PE after discharge.
Certainly, death of some cancer patients at home or in
longterm care facilities may have been due to PE, but
these but may not have been labeled as induced by PE
as the Adjudication Committee only accepts VTE events
that have been objectively confirmed. On the other hand,
in the RIETE registry selection bias was avoided by in
cluding consecutive patients with objectively confirmed,
symptomatic, acute VTE who were referred to study cen
Experimental Oncology 28, 245–247, 2006 (September) 247
ters. Enrolled patients were treated according to standard
practice, and prospective followup was completed for
all patients. Objective criteria were strictly applied for the
diagnosis of initial and recurrent VTE, including contrast
venography and pulmonary angiography if indicated,
and major bleeding was classified according to widely
accepted and validated criteria.
We conclude that arm DVT is a serious complication in
patients with cancer, with a high recurrence rate despite
anticoagulant therapy, as well as a high incidence of severe
bleeding complications. Accordingly, adequate identifica
tion of patients at risk, effective and safe prophylaxis, and
early confirmation of diagnosis is warranted.
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проблема тромбоза Глубоких вен у больных
онколоГическоГо профиля: анализ факторов риска.
Данные реГистра riete
Цель: обновить базу данных по клиническим характеристикам и течению заболевания у больных с тромбозом глубоких вен
верхних конечностей (ТГВ) с использованием системы регистра венозного тромбоэмболизма (СРВТ). Методы: СРВТ является
непрерывной системой регистрации больных с симптомами объективно подтвержденной острой венозной тромбоэмболии.
Проанализированы клинические характеристики и течение болезни на протяжении месяцев у больных онкологического профиля
с ТГВ. Результаты: в период декабря 2006 г. были обследованы 14 391 больных с симптоматической объективно подтвержден-
ной острой венозной тромбоэмболией при помощи системы СРВТ. Из 2945 больных с прогрессирующим течением заболевания
у196 (6,7%) человек выявили ТГВ верхних конечностей: у 104 — ассоциированный с катетером ТГВ. Большинство больных
с ТГВ верхних конечностей — лица мужского пола в возрасте моложе 65 лет и с низкой частотой дополнительных факторов
риска или первичного заболевания. У 20 из них (10%) отмечали симптомы эмболии легочной артерии (ЭЛА). Больные получали
низкомолекулярный гепарин и в начале исследования (94%), и по его окончании (75%). В течение последующих трех месяцев
у12 больных (6,1%) развился рецидив венозной тромбоэмболии (ВТЭ) (ЭЛА – у 6 больных, ТГВ – у 6 больных), у 8 (4,1%)
отмечали кровотечение (3 случая с летальным исходом), 43 (22%) пациента умерли. Выводы: данные СРВТ системы показали,
что ТГВ верхних конечностей является серьезным осложнением у больных, онкологического профиля, сочетающимся с высокой
степенью развития рецидива и осложнений, сопровождающихся кровотечениями.
Ключевые слова: рак, катетер, вена, тромбоз, фактор риска.
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