Öz
Objective: The incidence of upper limb deep vein thrombosis is rising in parallel with more frequent invasive vascular procedures. In this study we aimed to evaluate the upper limb deep vein thrombosis (ULDVT) cases retrospectively according to risk factors, symptoms, diagnosis and clinical course.Methods: Between January 2012 and May 2014, we studied 23 deep vein thrombosis cases which were confirmed with Doppler ultrasound. The patients were questioned about risk factors and underlying diseases and were examined with upper extremity venous Doppler ultrasonography. 15 cases had (65.2%) central venous catheter being the most common ULDVT reason.Results: Protocol included low molecular weight heparin in the acute phase and then oral anticoagulant for 6 months. All patients were followed at outpatient clinic with 2 month intervals for a year. Before completing the followup, 5 patients (21.7%) died of other reasons and we didn’t see any pulmonary embolus complication and recurrent DVT. None of the cases had post-thrombotic syndrome during follow-up.Conclusion: We suggest that LMWH must be preferred to standard heparin therapy because of its effectiveness, rare hemorrhage risk and easy usage to relieve symptoms, prevent recurrences, shorten the therapy period and decrease the costs
Anahtar Kelimeler
Deep vein thrombosis upper extremity low molecular weight heparin
Kaynakça
- Hasan K, Ednan B, Adem K, et al. Hipertansif kalp yetersizliği
- olan bir hastada masif sol aksiller-subklavyen ve sol
- juguler ven trombusu. Düzce Üniversitesi Sağlık Bilimleri
- Enstitüsü Dergisi 2012;2: 12-15.
- Hendler MF, Meschengieser SS, Blanco AN, et al. Primary
- upper-extremity deep vein thrombosis: high prevalence of
- thrombophilic defects. Am J Hematol 2004;76: 330-337.
- Özalp K, Ufuk Y, Hakan Ö. Approach to upper extremity
- deep vein thrombosis cases. DEÜ Tıp Fakültesi Dergisi
- :S 81-86.
- Shah MK, Black-Schaffer RM. Treatment of upper limb deep
- vein thrombosis with low molecular weight heparin. Am J
- Phys Med Rehabil 2003;82:415-417.
- Hill SL, Berry RE. Subclavian vein thrombosis: a continuing
- challenge. Surgery 1990;108:1-9.
- Schimp VL, Munkarah AR, Morris RT, et al. Upper extremity
- deep vein thrombosis associated with indwelling peripheral
- venous catheters in gynecology oncology patients. Gynecol
- Oncol 2003;89: 301-305
- Donayre CE, White GH, Mehringer SM, et al. Pathogenesis
- determines late morbidity of axillosubclavian vein thrombosis.
- Am J Surg 1986;152:179-184.
- Abufalia O, Sherer DM, DeEulis TG et al. Ultrasonographic
- diagnosis of catheter induced combined subclavian and jugular
- vein thrombosis. Am J Critical Care 1995;4:140-142.
- Alla VM, Natarajan N, Kaushik M, et al. Paget-schroetter
- syndrome: review of pathogenesis and treatment of effort
- thrombosis. West J Emerg Med 2010;11:358-362.
- Martinelli I, Battaglioli T, Bucciarelli P, et al. Risk factors
- and recurrence rate of primary deep vein thrombosis of the
- upper extremities. Circulation 2004;110:566-570..
- Héron E, Lozinguez O, Alhenc-Gelas M, et al. Hypercoagulable
- states in primary upper extremity deep vein thrombosis.
- Arch Intern Med 2000;160:382-386.
- Selçuk K, Hasan Fahri K, Deniz C, et al. Evaluation of
- patients with upper extremity deep vein thrombosis. Türk
- Göğüs Kalp Damar Cer Derg 2007;15:281-285.
- Baarslag HJ, van Beek EJ, Koopman MM, et al. Prospective
- study of color duplex ultrasonography compared with
- contrast venography in patients suspected of having deep
- venous thrombosis of the upper extremities. Ann Intern
- Med 2002;136: 865-872.
- Gooding GAW, Woodruff AYN. Color Doppler imaging in
- the subclavian – axillary region and upper extremity. Clin
- Imaging 1994;18:165-172.
- Melby SJ, Vedantham S, Narra VR, et al. Comprehensive
- surgical management of the competitive athlete with effort
- thrombosis of the subclavian vein (Paget-Schroetter syndrome).
- J Vasc Surg 2008;47:809-820.
- Walper JJ, Markel DC. Upper extremity deep venous
- thrombosis leading to pulmonary embolism after total hip
- arthroplasty. J Arthroplasty 2001;16:124-127.
- Massoure PL, Constans J, Caudry M, et al. Upper extremity
- deep venous thrombosis. 40 hospitalized patients. J Mal
- Vasc 2000;25:250-255.
- Becker DM, Philbrick JT, Walker FB. Axillary and subclavian
- venous thrombosis: prognosis and treatment. Arch Intern
- Med 1991; 151: 1934-1943.
- Prandoni P, Bernardi E. Upper extremity deep vein thrombosis.
- Curr Opin Pulm Med 1999;5:222-226.
- Kucher N. Clinical practice. Deep-vein thrombosis of the
- upper extremities. N Engl J Med 2011;364:861-869.
- Har-Noy O, Meltzer E. Upper-extremity deep-vein thrombosis
- in an elderly man. CMA 2007;176:1078-1079.
- Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis.
- Circulation 2002;106:1874-1880.
Öz
Amaç: Üst ekstremite derin venöz trombozları artan invazif vasküler girişimlere paralel olarak daha sıkça karşı- mıza çıkmaktadır. Bu çalışmada risk faktörleri, bulguları, tanısı ve tedavisi ile klinik gidişatını incelediğimiz üst ekstremite derin venöz tromboz (UEDVT) olgularımızı retrospektif olarak değerlendirmeyi amaçladık. Yöntemler: 2012 Ocak-2014 Mayıs tarihleri arasında Doppler ultrasonografi ile tanısı doğrulanan 23 derin venöz trombozlu olgu çalışmamıza dahil edilmiştir. Tüm hastaların risk faktörleri ve altta yatan hastalıkları sorgulanarak, üst ekstremite venöz Doppler ultrasonografik görüntülemeleri yapıldı. Olguların 15’inde (%65,2) santral venöz kateter mevcut olup bu risk faktörü en sık karşılaşı- lan UEDVT nedeniydi. Bulgular: Düşük molekül ağırlıklı heparin (DMAH) ve sonrasında ortalama 6 ay süreyle oral antikoagülan protokolü uygulandı. Tüm hastalar 2 aylık periyotlarla bir yıl süresince poliklinik takibinde tutuldu. Altta yatan hastalıklarına bağlı olarak 5 (%21,7) olgu takip periyotları tamamlanamadan kaybedildi. Pulmoner emboli komplikasyonu ve nüks DVT görülmedi. Hiçbir olguda takip süresince post-trombotik sendrom gelişmedi. Sonuç: Tedavide amaçlanan; semptomları giderme, nüksleri önleme ve tedavi süresi ile maliyetleri sınırlama amacıyla DMAH’ların uygulama kolaylığının yanısıra etkinliği ve kanama riskinin azlığı nedeniyle standart heparine tercih edilerek yüz güldürücü sonuçlar alınacağı kanaatindeyiz. Anahtar kelimeler: Derin venöz tromboz, üst ekstremite, düşük molekül ağırlıklı heparin
Anahtar Kelimeler
Derin venöz tromboz üst ekstremite düşük molekül ağırlıklı heparin
Kaynakça
- Hasan K, Ednan B, Adem K, et al. Hipertansif kalp yetersizliği
- olan bir hastada masif sol aksiller-subklavyen ve sol
- juguler ven trombusu. Düzce Üniversitesi Sağlık Bilimleri
- Enstitüsü Dergisi 2012;2: 12-15.
- Hendler MF, Meschengieser SS, Blanco AN, et al. Primary
- upper-extremity deep vein thrombosis: high prevalence of
- thrombophilic defects. Am J Hematol 2004;76: 330-337.
- Özalp K, Ufuk Y, Hakan Ö. Approach to upper extremity
- deep vein thrombosis cases. DEÜ Tıp Fakültesi Dergisi
- :S 81-86.
- Shah MK, Black-Schaffer RM. Treatment of upper limb deep
- vein thrombosis with low molecular weight heparin. Am J
- Phys Med Rehabil 2003;82:415-417.
- Hill SL, Berry RE. Subclavian vein thrombosis: a continuing
- challenge. Surgery 1990;108:1-9.
- Schimp VL, Munkarah AR, Morris RT, et al. Upper extremity
- deep vein thrombosis associated with indwelling peripheral
- venous catheters in gynecology oncology patients. Gynecol
- Oncol 2003;89: 301-305
- Donayre CE, White GH, Mehringer SM, et al. Pathogenesis
- determines late morbidity of axillosubclavian vein thrombosis.
- Am J Surg 1986;152:179-184.
- Abufalia O, Sherer DM, DeEulis TG et al. Ultrasonographic
- diagnosis of catheter induced combined subclavian and jugular
- vein thrombosis. Am J Critical Care 1995;4:140-142.
- Alla VM, Natarajan N, Kaushik M, et al. Paget-schroetter
- syndrome: review of pathogenesis and treatment of effort
- thrombosis. West J Emerg Med 2010;11:358-362.
- Martinelli I, Battaglioli T, Bucciarelli P, et al. Risk factors
- and recurrence rate of primary deep vein thrombosis of the
- upper extremities. Circulation 2004;110:566-570..
- Héron E, Lozinguez O, Alhenc-Gelas M, et al. Hypercoagulable
- states in primary upper extremity deep vein thrombosis.
- Arch Intern Med 2000;160:382-386.
- Selçuk K, Hasan Fahri K, Deniz C, et al. Evaluation of
- patients with upper extremity deep vein thrombosis. Türk
- Göğüs Kalp Damar Cer Derg 2007;15:281-285.
- Baarslag HJ, van Beek EJ, Koopman MM, et al. Prospective
- study of color duplex ultrasonography compared with
- contrast venography in patients suspected of having deep
- venous thrombosis of the upper extremities. Ann Intern
- Med 2002;136: 865-872.
- Gooding GAW, Woodruff AYN. Color Doppler imaging in
- the subclavian – axillary region and upper extremity. Clin
- Imaging 1994;18:165-172.
- Melby SJ, Vedantham S, Narra VR, et al. Comprehensive
- surgical management of the competitive athlete with effort
- thrombosis of the subclavian vein (Paget-Schroetter syndrome).
- J Vasc Surg 2008;47:809-820.
- Walper JJ, Markel DC. Upper extremity deep venous
- thrombosis leading to pulmonary embolism after total hip
- arthroplasty. J Arthroplasty 2001;16:124-127.
- Massoure PL, Constans J, Caudry M, et al. Upper extremity
- deep venous thrombosis. 40 hospitalized patients. J Mal
- Vasc 2000;25:250-255.
- Becker DM, Philbrick JT, Walker FB. Axillary and subclavian
- venous thrombosis: prognosis and treatment. Arch Intern
- Med 1991; 151: 1934-1943.
- Prandoni P, Bernardi E. Upper extremity deep vein thrombosis.
- Curr Opin Pulm Med 1999;5:222-226.
- Kucher N. Clinical practice. Deep-vein thrombosis of the
- upper extremities. N Engl J Med 2011;364:861-869.
- Har-Noy O, Meltzer E. Upper-extremity deep-vein thrombosis
- in an elderly man. CMA 2007;176:1078-1079.
- Joffe HV, Goldhaber SZ. Upper-extremity deep vein thrombosis.
- Circulation 2002;106:1874-1880.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Mayıs 2015 |
| Gönderilme Tarihi | 9 Mayıs 2015 |
| Yayımlandığı Sayı | Yıl 2015 Cilt: 42 Sayı: 1 |