Table A1

Risk in upper limb immobilisation

Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Blom JW, Doggen CJ, Osanto S, Rosendaal FR, November 2005, The Netherlands179 patients presenting between March 1999 and September 2003 with a first upper limb DVT. A comprehensive questionnaire was given to each individual in order to identify possible risk factors. These data were compared with those obtained from approx. 2400 control subjectsPopulation-based case–control study (level of evidence 3b)Adjusted OR for upper limb DVT in those with recent plaster cast immobilisation3/79 vs 7/2398=7 (95% CI 1.7 to 29.5)Relatively small number of cases. In addition, the study recruits participants from anticoagulant centres. Finally, the study only includes the use of plaster casts as ‘immobilisation’
Martinelli I, Battaglioli T, Bucciarelli P, Passamonti SM, Mannucci PM., August 2004, Italy115 patients presenting for thrombophilia screening after an episode of upper extremity DVTRetrospective cohort study (level of evidence 2b)No. of individuals with documented upper limb immobilisation prior to an upper limb DVT0%The patients were recruited from a centre for thrombophilia screening, perhaps resulting in some bias in the population represented in this study. Also this is a relatively small study (115) involving only one centre
Patients with preceding upper limb trauma4%
Marinella et al, 2000, USA90 adult patients with DVT of the internal jugular, subclavian, axillary or brachial vein over a 5-year periodRetrospective observational cohort study in a large urban teaching hospital (level of evidence 2b)Prevalence of most common underlying risk factors for upper extremity DVTCVC 72%, infection 28%, extrathoracic malignancy 22% and recent surgery 21%Retrospective study of a small cohort. In addition, as it is a retrospective study, it is difficult to know whether patients had underlying hypercoagulable states, eg factor V Leiden mutation as most patients were not evaluated for such conditions
Spencer et al, 2007, the USA and Canada483 adult patients with validated acute DVT, 14% of whom (69 patients) were diagnosed with upper extremity DVTRetrospective observational cohort study (level of evidence 2b)Upper extremity DVT risk factors (%) (n=69)CVT 62.3%, surgery within the 3 months prior to DVT diagnosis 48.5%, fracture within 3 months of DVT diagnosis 15.9%A small sample size. The medical record limits the information available on patient medical history and clinical characteristics
  • DVT, deep vein thrombosis; CVC, central venous catheter; CVT, central venous thrombosis.