Clinical and prognostic differences between upper and lower extremity deep vein thrombosis: Findings of the RIETE Registry

Objectives: Data from the Registro Informatizado de Enfermedad TromboEmbolica (RIETE) used to evaluate differences in risk factors, treatment strategies and outcomes in patients with catheter and non-catheter related upper-extremity deep vein thrombosis (UEDVT) and lower-extremity deep vein thrombosis (LEDVT). Methods: Clinical characteristics, treatment details and 90-day outcomes were compared. Results: Of 54,184 patients enrolled, 28,501 (53%) had a LEDVT, 941 (1.7%) had a non-catheter UEDVT and 627 (1.2%) had a catheter UEDVT. As to baseline, LEDVT-patients presented more pulmonary embolisms (PE) (p <0.001), while catheter-related UEDVT had more frequently anemic, cancer, or previous major bleeding (p<0.001). Factor V Leiden and Prothrombin G20210A were more associated with LEDVT (p<.05). LEDVT were initially treated with Low-Molecular-Weight-Heparin (LMWH) more than non catheter-related UEDVT (p<.001). At 90-days follow-up, catheter-related UEDVT experienced more recurrent PEs and major bleeding (p<0.05); UEDVT presented a higher risk of infection and respiratory insufficiency (p<0.05), and higher mortality (p<0.001). As to initial treatment of UEDVT were less frequently administered LMWH and vitamin K antagonists (VKA); as to long-term therapy more LEDVT were treated with VKA than UEDVT (p<01). Conclusions: patients with UEDVT had a higher incidence of recurrent PE, a higher risk of bleeding, infection and respiratory insufficiency. These patients received fewer doses of LMWH and vitamin K antagonists, but were more frequently treated with unfractionated heparin.