Patient Care

Clinical Session


ELIZABETH BARLOW, MD, MPP, wants all hospitalists to know that upper-extremity DVT (UEDVT) is on the rise. Although most think of it “as a lesser entity,” Dr. Barlow told a jam-packed clinical-track session at HM10 the data show a higher rate of pulmonary em-bolism [PE] occurrence in UEDVT than was first thought. “So I think treating it seriously is important,” she said.

Theresa Cucco, MD, absorbs pearls of wisdom during one of the clinical-track sessions.

Theresa Cucco, MD, absorbs pearls of wisdom during one of the clinical-track sessions.

Dr. Barlow, a hospitalist at the University of Chicago Medical Center, outlined the case for greater attention to UEDVT during “Controversies in Anticoagu-lation and Thrombosis. “UEDVTs make up 1% to 4% of all DVTs in the U.S., and nearly 80% of UEDVT cases are provoked.

Much of the rise in—and controversy—UEDVT is due to the increased use of in-dwelling catheters, primarily how long to leave the catheter in place and when to remove it. “Judicious use of catheters is necessary. You should leave it in, if you need it,” Dr. Barlow said, adding that hospitalists should weigh the benefits and risks of PICC lines.

Some of Dr. Barlow’s key take-home points:

  • Treat UEDVT seriously;
  • Understand there is a higher rate of PE than previously thought;
  • Insert central-vein catheters judiciously, and keep them in if you still need them;
  • Manage the duration of therapy parallel to that of lower extremity DVT; and
  • Routine thrombolytics use isn’t indicated at this time. HM10

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