Is anticoagulation (AC) therapy recommended for treatment of vein thrombosis of upper extremities?

The short answer is “yes” when deep veins, such as brachial, axillary or subclavian are involved; cephalic and basilic veins are superficial. Although some have suggested that isolated brachial vein thrombosis may be considered at low risk of complication, this assumption has not been corroborated by objective research (1).

There are no randomized trials of AC therapy in patients with upper extremity deep vein thrombosis (UEDVT).  However,  the American College of Chest Physicians has recommended a 3-month course of AC therapy similar to that of leg DVT for several reasons (1,2): 1. UEDVT has generally been reported to have complications and consequences comparable to that of leg DVT; 2. Several small cohort studies suggest lower rates of recurrent DVT, PE, and bleeding when treated similarly to leg DVT; and 3. The demonstrated benefit of AC therapy in leg DVT. In addition, post-thrombotic syndrome is relatively common (about 1 in 5) among patients with UEDVT (2).

References

1.  Hingorani A, Ascher E, Marks N, et al. Morbidity and mortality associated with brachial vein thrombosis. Ann Vasc Surg 2006; 20:297-299.

2. Kearon C, Akl EA, Comerato AJ, et al. Antithrombotic therapy for VTE disease: American College of Chest Physicians Antithrombotic Therapy and Prevention of Thrombosis Panel. Antithrombotic therapy for VTE disease: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest 2012;141(suppl):419S-494S.

2. Maynard G. Upper extremity deep vein thrombosis:A call to arms.JAMA Intern Med 2014;696-698.

Is anticoagulation (AC) therapy recommended for treatment of vein thrombosis of upper extremities?