Permanent Pacemaker-Related Upper Extremity Deep Vein Thrombosis: A Series of 20 Cases

• Published in: Pacing and clinical electrophysiology 2012-10, Vol.35 (10), p.1194-1198
• Main Authors: MANDAL, SAROJ, PANDE, ARINDAM, MANDAL, DEBOSMITA, KUMAR, ASUTOSH, SARKAR, ACHYUT, KAHALI, DHIMAN, MAZUMDAR, BISWAKESH, PANJA, MANOTOSH
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Anticoagulants - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Defibrillators, Implantable - adverse effects; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart Failure - complications; heparin; Heparin - therapeutic use; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; pacemaker; Pacemaker, Artificial - adverse effects; Radiography; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Risk Factors; Severity of Illness Index; Stroke Volume - physiology; Subclavian Vein - diagnostic imaging; Treatment Outcome; Upper Extremity Deep Vein Thrombosis - drug therapy; Upper Extremity Deep Vein Thrombosis - etiology; upper extremity DVT; warfarin; Warfarin - therapeutic use
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2012.03467.x

Background:  Upper extremity deep vein thrombosis (DVT) has become a common occurrence nowadays due to emergence of multiple newer risk factors, such as implantation of permanent pacemaker (PPM) and implantable cardioverter‐defibrillators. We are reporting 20 cases of upper extremity DVT related to PPM implantation. Methods and Result:  All the patients presented within 6 months, with unilateral upper extremity swelling (90%), pain (45%), erythema (15%), and other less frequent features. Venography established the diagnosis in all the cases. Considering the distribution of possible risk factors of venous thrombosis among our patients, diabetes was the most frequent (present in 45%) followed by smoking (35%), hypertension (30%), obesity with body mass index ≥30 (30%), history of acute myocardial infarction (25%), chronic obstructive pulmonary disease (20%), and history of congestive cardiac failure (15%). Antiplatelets were not found protective against the development of this situation. There was no statistically significant difference in respect to venous access, number of leads, use of previous temporary pacing lead, or poor left ventricular systolic function (ejection fraction ≤40%) among the six patients who presented with complete occlusion of subclavian vein compared to the rest of the 14 patients who had partial occlusion. There were complete resolutions of symptom in 85% of patients after 6 months of anticoagulation therapy in the form of initial intravenous unfractinated heparin followed by oral warfarin. Conclusion:  Anticoagulation with warfarin for 6 months with initial intravenous unfractionated heparin was a safe and effective mode of therapy in most of the patients with PPM related upper extremity DVT. (PACE 2012; 35:1194–1198)