Upper extremity thrombosis and risk for DVT of lower extremities

Paget-Schroetter syndrome and subclavian vein thrombosis are very rarely discussed. Could you comment on these diseases and the risk of pulmonary embolism? Is this a risk for deep venous thrombosis of the lower extremity? What would be your approach to such patients?

Jeffrey Weitz: If the patient has an upper extremity thrombosis, there are different etiologies. The ones that we see most often are the ones in association with central venous catheters, peripherally inserted central catheter (PICC) lines, port-a-caths, particularly in cancer patients or patients getting total parenteral nutrition or antibiotics parenterally. There the risk factor is the line; you treat them, you take out the line, their risk goes back to baseline.

You have patients with upper extremity thrombosis who may have some compression. Those patients might benefit from surgical decompression. We tend not to be as aggressive as some of our American colleagues but some people believe that there is a role for that. If you have venous thromboembolism (VTE) in any location, upper extremity, it is a risk factor for recurrent VTE even in the lower extremities, so I would be thinking about it. I would definitely prophylax that person aggressively if they come into hospital for some other illness. I would give them prophylaxis; I would give anyone prophylaxis who comes into hospital and is at risk for thrombosis.