Key result
Upper extremity deep vein thrombosis was not associated with a different rate of pulmonary embolism compared to lower extremity deep vein thrombosis.
Why the study?
It is commonly believed that upper extremity DVT is less likely to develop into PE than lower extremity DVT, but evidence supporting this validity is lacking.
Does the rate of pulmonary embolism differ between patients with upper extremity DVT versus lower extremity DVT in the neurocritical care unit?
Observational (n=97)
Does the rate of pulmonary embolism differ between patients with upper extremity DVT versus lower extremity DVT in the neurocritical care unit?
In neurocritical care patients, upper extremity DVT carries a similar risk of pulmonary embolism as lower extremity DVT, suggesting both may warrant similar consideration for anticoagulation.
Answers are grounded in this paper and cite their sources.
No difference in PE coexistence with UEDVT versus LEDVT in neuro ICU patients; challenges common belief but leaves open treatment implications.
BACKGROUND: Patients in the neurological intensive care unit (ICU) are at an increased risk of venous thromboembolism (VTE). Anticoagulation is often indicated because deep venous thrombosis (DVT) can develop into pulmonary embolism (PE). However, anticoagulation also increases the risk of intracranial bleeding. Physicians must weigh the opposing risks carefully. It is commonly believed that upper extremity DVT (UEDVT) is less likely to develop into PE as compared to lower extremity DVT (LEDVT), but this lacks evidence, and our study investigates its validity. METHODS: Retrospective review of patients admitted to a neurologic ICU from 2017 to 2022 who developed VTE. RESULTS: We reviewed 2891 patients and 97 patients met study criteria. VTE occurred in 3.55% of patients, DVT in 2.63%, and PE in 0.96%. Of the recorded DVTs, 52.3% were in the upper extremities, 42.3% in the lower extremities, and 6.4% in both. PE rate was not significantly different in patients with UEDVT than in those with LEDVT (P = 0.233). Cather-associated DVT was more common in the upper extremities (P = 0.002), but the PE rate was no different in catheter-associated DVT than non-catheter-associated DVT (P = 0.193). The proportion of patients treated with therapeutic anticoagulation was not significantly different between patients with UEDVT alone and those with LEDVT (P = 1.000). CONCLUSIONS: In this sample of neurocritical care patients, the coexistence of DVT and PE did not differ in patients with upper versus lower extremity DVT. This should be considered in the neurocritical care unit when deciding whether to treat patients with DVT with anticoagulants.
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Mufti et al. (2025) conducted an observational in Venous thromboembolism in neurocritical care (n=97). Upper extremity deep vein thrombosis vs. Lower extremity deep vein thrombosis was evaluated on Pulmonary embolism rate (p=0.233). Upper extremity deep vein thrombosis was not associated with a different rate of pulmonary embolism compared to lower extremity deep vein thrombosis.
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