Axillary of subclavian thrombosis: long-term symptoms were common.

Clinical bottom line (level 4)

  1. Approximately a third of patients who had an axillary or subclavian thrombosis suffered symptoms after treatment.
  2. Around a tenth of patients developed a pulmonary embolism and 1% died.
Becker et al: Archives of Internal Medicine 1991; 151: 1934-1943
Expires May 2003

The study

Systematic review of all of
  • Patients: axillary or subclavian thrombosis
  • Outcome: reporting of post-treatment symptoms, pulmonary embolism and death


    • Articles found in English using MEDLINE and Index Medicus, 1950 to 1989 (search terms: axillary thrombophlebitis, subclavian thrombophlebitis ) and review of 'Current Contents' (January to March 1990) and review of all relevant citations in each article located

    Selection criteria: as above
    Appraisal criteria: three independent reviewers using a grading system
    Articles excluded if: none given

    71 case reports of 112 patients and 17 case series of 217 patients

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    post-treatment symptoms ? 112/329 34.0%
    (28.9% to 39.2%)
    pulmonary embolism ? 31/329 9.42%
    (6.27% to 12.6%)
    death ? 4/329 1.22%
    (0.0320% to 2.40%)

    • Outcomes were not affected by the cause of thrombosis.

    Comments

    1. The studies in general, were poor; few had patients at a similar point at inception, and some had been previously treated. Figures quoted may be grossly inaccurate, and do not concord with clinical experience.
    2. Methods used to detect adverse outcomes were unblinded, rarely objective (eg. PE was only half diagnosed by v/q or angiogram), and open to bias.
    3. The greatly increased use of indwelling catheters for chemotherapy may have altered the spectrum of patients now observed.

    Citation

    1. Becker DM, Philbrick JT, Walker FB: Axillary and subclavian venous thrombosis: prognosis and treatment. Archives of Internal Medicine 1991; 151: 1934-1943
    Contributor: Chris Ball and Clare Wotton, May 2000
    Reviewer: Alex Gallus

    Clinical Question.
    Patient venous thrombosis
    Intervention or Exposure prevalence, upper limb
    Outcome pulmonary embolism, death, prevalence