Risk in upper limb immobilisation
| Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study weaknesses |
|---|---|---|---|---|---|
| Blom JW, Doggen CJ, Osanto S, Rosendaal FR, November 2005, The Netherlands | 179 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 subjects | Population-based case–control study (level of evidence 3b) | Adjusted OR for upper limb DVT in those with recent plaster cast immobilisation | 3/79 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, Italy | 115 patients presenting for thrombophilia screening after an episode of upper extremity DVT | Retrospective cohort study (level of evidence 2b) | No. of individuals with documented upper limb immobilisation prior to an upper limb DVT | 0% | 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 trauma | 4% | ||||
| Marinella et al, 2000, USA | 90 adult patients with DVT of the internal jugular, subclavian, axillary or brachial vein over a 5-year period | Retrospective observational cohort study in a large urban teaching hospital (level of evidence 2b) | Prevalence of most common underlying risk factors for upper extremity DVT | CVC 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 Canada | 483 adult patients with validated acute DVT, 14% of whom (69 patients) were diagnosed with upper extremity DVT | Retrospective 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.