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Prepublished online as a Blood First Edition Paper on December 27, 2002; DOI 10.1182/blood-2002-05-1448.
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Blood, 15 April 2003, Vol. 101, No. 8, pp. 3049-3051
HEMOSTASIS, THROMBOSIS, AND VASCULAR BIOLOGY
Brief report
Central venous catheters and upper-extremity deep-vein thrombosis
complicating immune heparin-induced thrombocytopenia
Aaron P. Hong,
Deborah J. Cook,
Christopher S. Sigouin, and
Theodore E. Warkentin
From the Department of Pathology and Molecular
Medicine, the Department of Medicine, and the Department of
Anaesthesia, McMaster University, and the Hamilton Regional Laboratory
Medicine Program, Hamilton, ON; and the Department of Health Policy,
Management and Evaluation, University of Toronto, and Program in
eHealth Innovation, University Health Network, Toronto, ON,
Canada.
Heparin-induced thrombocytopenia (HIT) is a transient
antibody-mediated hypercoagulability state strongly associated with lower-limb deep-vein thrombosis (DVT). Whether HIT is additionally associated with upper-limb DVT either with or without central venous
catheter (CVC) useis unknown. We therefore studied 260 patients with
antibody-positive HIT to determine the influence of CVC use on
frequency and localization of upper-extremity DVT in comparison with 2 non-HIT control populations (postoperative orthopedic surgery and
intensive-care unit patients). Compared with the control populations,
both upper- and lower-extremity DVTs were found to be associated
with HIT. Upper-extremity DVTs occurred more frequently in HIT patients
with a CVC (14 of 145 [9.7%]) versus none of 115 (0%)
patients without a CVC (P = .000 35). All
upper-extremity DVTs occurred at the CVC site (right, 12; left, 2;
kappa = 1.0; P = .011). We conclude that a localizing vascular injury (CVC use) and a systemic hypercoagulability disorder (HIT) interact to explain upper-extremity DVT complicating HIT.
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