Research from Argentina suggests that hypercoaguability may play a significant role in the etiology of upper-extremity deep vein thrombosis (UEDVT).
Between 1993 and 2002, 15 cases of effort-related and 16 cases of spontaneous UEDVT, which occurred in a total of 31 patients, were referred to the Academia Nacional de Medicina de Buenos Aires for thrombophilia testing. These included 17 women and 14 men with a median age of 38.8 years and 31.4 years, respectively.
Overall, 61.3% of patients were found to have one or more coagulation abnormality, Mariela Hendler and co-workers from the institution report.
The most common forms of acquired thrombophilic factors were antiphospholipid antibodies against lupus anticoagulant (31%) and anticardiolipin antibodies (12.9%).
In addition, 12.9% and 20% of patients carried the Factor V Leiden and prothrombin G20210A mutations, respectively, while a further 16.1% had elevated levels of homocysteine. One (4.7%) patient was diagnosed with protein S deficiency.
Although effort-related UEDVT was associated with male gender and younger age, there was no difference in the prevalence of acquired or inherited forms of hyperocoaguability in patients with effort-related or spontaneous events.
Hendler et al also detected anatomic abnormalities in 22.5% of the patients, and found that these individuals were significantly less likely to have thrombophilia than those without such defects. Specifically, thrombophilic factors were 5.25 times more common in patients without anatomic abnormalities than in affected individuals.
"This study found a high prevalence of an underlying thrombophilic status in spontaneous and effort-related UEDVT," the authors report in the American Journal of Hematology.
"Hypercoagulable status may play a significant role in both groups."
They therefore conclude: "Screening for local anatomical abnormalities and thrombophilia should be included in the evaluation of primary UEDVT."