Hypercoagulable States in Primary Upper-Extremity Deep Vein Thrombosis

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Abstract
THE ROLE of hypercoagulability as a risk factor for lower-extremity deep vein thrombosis (DVT) has been shown in large epidemiological studies. The overall rate of the main clotting abnormalities (antithrombin, protein C, and protein S deficiencies; factor V Leiden; and antiphospholipid antibodies) in unselected patients with lower-extremity DVT is close to 30%,1,2 with the highest prevalence in patients with primary thromboses.2 There are very few data on the prevalence of coagulation abnormalities in primary upper-extremity DVT (UEDVT). Three recent studies3-5 provided estimates of the prevalence of clotting abnormalities in patients with primary UEDVT ranging from 8%5 to 43%3; these findings led to questions about the need for laboratory investigations in such patients. Primary UEDVT classically comprises effort-related thrombosis (Paget-Schroetter syndrome), which consists of axillary-subclavian vein thrombosis following strenuous activity of the affected arm; it also includes idiopathic UEDVT, in which no obvious associated disease or triggering factor is found. The dominant role of mechanical factors in the pathogenesis of effort-related UEDVT has been emphasized by the frequency of anatomical compressive abnormalities at the thoracic outlet in such cases.6 The aim of our study was to determine if coagulation abnormalities could be a significant contributing factor in effort-related UEDVT and/or idiopathic UEDVT, in which the role of mechanical triggering factors is less obvious.

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