Post-Thrombotic Syndrome and Recurrent Thromboembolism in Patients with Upper Extremity Deep Vein Thrombosis: A Systematic Review and Meta-Analysis of Proportions
Bibliographic record
Abstract
Abstract Background: Upper extremity deep vein thrombosis (UEDVT) is known to be less common than lower extremity DVT (LEDVT). In comparison to LEDVT, there is limited data on the occurrence of complications in patients with UEDVT. As a result, it remains uncertain as to how aggressively these patients should be treated. In this systematic review, we aimed to determine the rate of complications, including post-thrombotic syndrome and recurrent thromboembolism, in patients with UEDVT. Methods: We conducted a systematic literature search of MEDLINE and EMBASE databases for relevant studies from 1970 onwards. Our search included conference publications from major international meetings. Studies were eligible for inclusion if they were observational studies (case-control, cohort), randomized trials, or cases series including more than 20 patients. Studies must have included only patients age 18 or older and have objectively diagnosed UEDVT by means of venography or ultrasound. The primary outcome measures were the recurrence rate of UEDVT in patients with previously documented UEDVT and the rate of PTS. The secondary outcome measure was the rate of major bleeding, as defined by the International Society on Thrombosis and Haemostasis (ISTH), following the initiation of treatment for UEDVT. For each outcome, we calculated a pooled proportion using a fixed effects model and its 95% confidence interval (CI) using the Wilson score method. We also determined the mean proportions of outcomes and the interquartile ranges (IQR) of single proportions from individual studies. Results: A total of 61 studies were included in the meta-analysis (58 full text articles and 3 conference publications). The studies included a total of 5500 patients diagnosed with UEDVT. Of the 61 included studies, 39 reported data on recurrence, 21 on PTS, and 28 on major bleeding. PTS was defined either by the Villalta scale explicitly (a score of 5 or more) or by similar clinical descriptors posed by the investigators. The results are summarized in Table 1. When evaluating all studies, the pooled proportions of outcomes were: 2.4% (95% CI: 2.0-2.9%) for recurrence, 15.0% (95% CI: 12.8-17.5%) for PTS, and 2.9% (95% CI: 2.5-3.5%) for major bleeding. The mean proportions were: 8.4% (IQR: 0.0-10.1%), 18.4% (IQR: 0.0-26.7%), and 4.3% (IQR: 0.0-5.7%), respectively. When evaluating studies specific to primary UEDVT in the setting of venous thoracic outlet syndrome, the pooled proportions were: 5.5% (95% CI: 4.3-7.1%) for recurrence, 16.0% (95% CI: 13.4-19.0) for PTS, and 3.3% (95% CI: 2.0-5.3%) for major bleeding. The mean proportions were: 6.8% (IQR: 0.0-9.5%), 19.6% (IQR: 0.0-30.5%), and 3.2% (IQR: 0.0-4.8%), respectively. When evaluating studies specific to secondary UEDVT (catheter-associated and/or malignancy-associated), the pooled proportions were: 2.0% (95% CI: 1.5-2.6%) for recurrence, 8.0% (95% CI: 4.9-12.8) for PTS, and 3.9% (95% CI: 3.2-4.8%) for major bleeding. The mean proportions were: 18.1% (IQR: 1.5-18.4%), 17.1% (IQR: 9.8-26.5%), and 3.8% (IQR: 0.0-5.2%), respectively. Conclusions: This review included a large number of patients diagnosed with UEDVT and found that both primary and secondary UEDVT are associated with high rates of PTS. The pooled proportions of PTS and recurrent thromboembolism were higher in patients with primary UEDVT than in patients with secondary UEDVT. The rates of major bleeding were similar in both groups. Further analysis is needed on the association of these complications with different treatment modalities for UEDVT to better guide the management of patients. Our next step is to calculate pooled proportions using a random effects model and present this data at the 59th American Society of Hematology (ASH) Annual Meeting. Download : Download high-res image (98KB) Download : Download full-size image Disclosures Lazo-Langner: Pfizer: Honoraria; Bayer: Honoraria; Daiichi Sankyo: Research Funding; Alexion: Research Funding.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.013 | 0.031 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.020 | 0.037 |
| Bibliometrics | 0.008 | 0.010 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".