One study found an almost 24% rate of previously undiagnosed cancer in patients with what was originally diagnosed as a “primary” DVT.1

After receiving a CVC, up to 6% of patients will develop symptomatic UE-DVTs compared with near 20% developing asymptomatic UE-DVTs.1

One example of a CVC with growing popularity within the cancer population is the peripherally inserted central catheter (PICC). PICCs are becoming more common in all patient subgroups, especially those with cancer. PICCs are placed in patients with cancer for a multitude of reasons including poor peripheral intravenous access and for administration of chemotherapy and total peripheral nutrition.


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When a PICC is placed in a patient with cancer, there are certain risk factors that increase the risk of developing an UE-DVT including the presence of chronic medical conditions (diabetes and chronic obstructive pulmonary disease), presence of metastases, catheter size, and number of lumens.1,3

Patients with UE-DVTs can present with low grade fevers along with pain, swelling, and erythema of the affected extremity. Upper extremity ultrasound is typically the imaging modality of choice when diagnosing a DVT, however computed tomography (CT) and magnetic resonance imaging (MRI) have also been used.

Treatment of UE-DVTs is somewhat controversial and patient-specific. If a patient with cancer is treated, a low molecular weight heparin such as enoxaparin is preferred, however a heparin to warfarin-bridge can also be considered.

RELATED: Optimal Heparin Treatment in Residual Vein Thrombosis (RVT) Patients Found

Typically the patient would be treated for at least 3 months, but potentially longer regimens have been used.2

When the UE-DVT is most likely secondary to a CVC, the catheter does not always have to be removed. Potential indications to remove the CVC include contraindications to anticoagulation, infected and/or malfunctioning catheters, and worsening UE-DVT despite treatment.2

References

  1. Grant JD, Stevens SM, Woller SC, et al. Diagnosis and management of upper extremity deep-vein thrombosis in adults. Thromb Haemost. 2012;108(6):1097-1108.
  2. Engelberger RP, Kucher N. Management of deep vein thrombosis of the upper extremity. Circulation. 2012;126(6):768-773.
  3. Aw A, Carrier M, Koczerginski J, et al. Incidence and predictive factors of symptomatic thrombosis related to peripherally inserted central catheters in chemotherapy patients. Thromb Res. 2012;130(3):323-326.