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Forum Name: Hematology Topics

Question: UEDVT-Upper Extremity DVT/help please


 LFD0884 - Thu Oct 20, 2005 11:37 pm

Help,
I have recently had elective arthroscopic surgery on my right shoulder to relieve compression and Labrum tear pain. I am a 34 year old male, healthy, active, and a muscular 240 pounds. I have no underlying medical conditions that I or my Physicians are aware of. I have NKDA. Within 2 days I developed a UEDVT in both brachial veins and the vein they attach to (I can't remember its name) in my right arm. I have a small amount of swelling in the inside portion of the right bicep and some redness from under my arm in the armpit to mid forearm. I had the UEDVT confirmed via ultrasound. It appears that the clot(s) extend from in the armpit to just below my elbow. My arm is not grossly swollen and has good PMS. I have been put on 120mg Lovenox and 2.5mg Coumadin as my treatment and nothing more. I had the formation of a clot in my lower left calf following left knee surgery 7 years ago and received no anti-coagulant therapy then with complete resolution and no known problems associated with my previous clot. From everything I have read I may have some protein deficiencies and possibly other problems to look into in the future. But my immediate concern is the treatment of my UEDVT. I have read about long term Post-Thrombi-Syndrome and its potential debilitating effects. I have also read about possible incomplete clot removal from just LMWH and Coumadin therapy and potential to have a PE later in life. I am a Fire Fighter who leads and active professional and personnel life. How concerned should I be about the potential debilitating effects of these complications? Should I insist on a more aggressive treatment with Thrombolitics via catheter injection directly to the clot(s) followed by LMWH? Currently my medical treatment is being monitored by my Orthopedic Surgeon and have not seen a blood clotting specialist. What type of Physician/Specialist should I see regarding treatment of my UEDVT? I want the best treatment and best outcome, and am worried about dying on my family from a PE or other related clot problem now and in the future, please help.
Thank you, Jason T
 Dr. Safaa Mahmoud - Sun Jul 16, 2006 9:53 pm

User avatar Dear LFD0884,

Idiopathic UEDVT is diagnosed by exclusion when none of the risk factors for UEDVT is present. Only 20% of cases can be of Idiopathic cause.

Secondary UEDVT occurs due to two types of risk factors:
Exogenous risk factors like:
central venous lines,
cancers,
history of similar attack due to leg deep venous thrombosis,
oral contraceptives, and
severe trauma is the major factor in the development of UEDVT.

Occult malignancy in particular lung cancer and lymphomas is sometimes discovered during the follow-up in 24% of patients.

Studies reported a contributing role for blood clotting factors like antithrombin III, protein C and protein S defects, factor V Leiden and G20210A prothrombin mutation etc.
So it is wise to search for coagulation abnormalities in patients with Idiopathic UEDVT.

Treatment is basically with Therapeutic dose of unfractionated or low-molecular-weight heparin followed by oral anticoagulation for at least 3 months.

I hope these informations are helpful, I advise you to follow up with your doctor and to consult a vascular surgeon for proper medical care.

Best regards

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