Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs
Version of Record online: 15 MAY 2013
© 2013 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 11, Issue 5, pages 836–844, May 2013
How to Cite
Upper limb arterial thromboembolism: a systematic review on incidence, risk factors, and prognosis, including a meta-analysis of risk-modifying drugs. J Thromb Haemost 2013; 11: 836–44., , ,
- Issue online: 15 MAY 2013
- Version of Record online: 15 MAY 2013
- Accepted manuscript online: 25 FEB 2013 05:49AM EST
- Manuscript Accepted: 15 FEB 2013
- Manuscript Received: 23 AUG 2012
- atrial fibrillation;
- upper limb
The aim of this review is to focus on risk factors, risk-modifying drugs and prognosis for upper limb arterial thromboembolism, and the relationship between upper limb arterial thromboembolism and atrial fibrillation (AF).
We searched MEDLINE for studies on the epidemiology of upper limb thromboembolism from 1965 to June 2012. We also searched for contemporary, phase III randomized trial data on systemic (non-stroke) thromboembolism comparing warfarin with new oral anticoagulants (OACs) in patients with atrial fibrillation published after the year 1999.
The incidence of upper limb thromboembolectomy was 3.3 per 100 000 person-years among men and 5.2 per 100 000 person-years among women; the risk of limb amputation, stroke and death after thromboembolectomy was increased. There was an increased risk of thromboembolectomy of the upper limb in patients with AF diagnosed with hypertension (hazard ratio [HR] 2.2–2.9), myocardial infarction (HR 2.9–3.9), heart failure (HR 1.6–1.9), and stroke (HR 2.2–3.8). For those diagnosed with diabetes mellitus, the risk was non-significantly increased by 1.2–1.4. Females had a 1.8-fold (95% confidence interval [CI] 1.5–2.3) fold increased risk of thromboembolectomy as compared with men. The risk reduction for systemic embolism with new OACs as compared with warfarin in patients with AF is similar to that seen with warfarin (odds ratio 0.79, 95% CI 0.38–1.64).
Age, female sex, AF, hypertension, diabetes, myocardial infarction, heart failure and stroke are most common risk factors for thromboembolectomy of the upper limb. The availability of new OACs holds promise for reducing the risk of systemic thromboembolism, but specific data are still limited.