Upper Extremity Deep Vein Thrombosis

Understanding Thrombosis

What is Upper Extremity Deep Vein Thrombosis?

Upper extremity deep vein thrombosis (UEDVT), sometimes called an arm blood clot or arm DVT, occurs when a blood clot forms in one of the deep veins of the arm, shoulder or upper chest rather than the leg. It most often develops in the axillary, subclavian or brachial veins.1  A DVT in the arm is far less common than a DVT in the leg, though it has become more frequent in recent years, largely because central venous catheters are used more often today.23

Doctors generally sort UEDVT into two categories and knowing the difference matters because it changes the workup and treatment plan:

Primary UEDVT

Primary UEDVT develops without a catheter or another obvious medical trigger. The most common form is Paget-Schroetter syndrome, also called effort thrombosis, which happens when repetitive or strenuous arm movement compresses the subclavian vein at the thoracic outlet (the space between the collarbone and first rib), damaging the vein wall and triggering a clot. It typically affects younger, otherwise healthy, physically active people, including swimmers, weightlifters, throwing athletes and workers whose jobs involve repetitive overhead motion.14 Primary UEDVT makes up an estimated 10% to 20% of all upper extremity clots.5

Secondary UEDVT

Secondary UEDVT is far more common and is linked to an identifiable cause, most often a central venous catheter, PICC line (peripherally inserted central catheter) or port used for chemotherapy, dialysis or long-term IV medication. Active cancer, pacemaker or defibrillator leads, and inherited or acquired clotting disorders also raise the risk.16

Learn more about upper-extremity DVT
What is upper-extremity DVT
Pain or a heavy aching feeling can be a sign of a blood clot in the arm
Understanding upper extremity DVT

Upper extremity DVT signs and symptoms

Common signs of upper-extremity deep vein thrombosis include:

  • Pain and tenderness to touch in the arm or armpit area, or the neck area below the jaw or above the collar bone.
  • Warmth along the neck, armpit, arm or hand.
  • Discoloration of these areas, especially redness along the middle or inner part of the arm.
  • Swelling in the arm, especially over the middle and inner part of arm and the back of hand.

Patients should seek immediate medical attention if they experience sudden arm swelling or severe pain.

 

Understanding upper extremity DVT

Upper extremity DVT risk factors

Implantation of long catheters into the veins, referred to as “PICC lines” or “central venous catheters”, as well as placement of smaller, peripheral intravenous catheters in the arm or hand veins, can irritate the veins in the arm or neck veins and can increase the risk of developing blood clots.

Implantation of heart devices, such as pacemakers, can also increase the risk of developing blood clots, but this usually occurs in the neck veins.

Patients with cancer who require long-term intravenous access through central lines face the highest risk, since the chemotherapy they are receiving may also, along with the catheter, irritate the veins and causing a blood clot

Patients who require treatment with hemodialysis can also develop blood clots at the dialysis access sites (central venous catheters, arteriovenous fistulas), usually located in the arm or neck area.

Upper extremity DVT is also called an arm blood clot
Most upper extremity DVTs occur because of pressure, blockage or direct injury to the veins
Understanding why it happens

What causes an upper extremity DVT?

Most upper extremity DVTs occur because of pressure, blockage or direct injury to the veins as they exit the arm and shoulder toward the chest. Additional specific causes include:

  • Thoracic outlet syndrome when the upper ribs or surrounding muscles press on the veins or nerves passing through the thoracic outlet
  • Effort-induced injury can develop after vigorous, repetitive activity with repetitive arm movements, such as in swimmers, weightlifters, athletes who throw shot put, javelin, etc. or people whose job entails repetitive, vigorous arm movements.
  • Presence of a central venous catheter, PICC line or port, which can irritate the vein lining and encourage clot formation9
  • Direct vein injury from trauma or surgery

Upper extremity DVT treatment options

Treatment for UEDVT depends on where the clot is, what caused it and each patient’s overall health. Options include:

  • Anticoagulation (blood thinners). This is the mainstay of treatment for most patients. Options include low molecular weight heparin, direct oral anticoagulants (DOACs) or warfarin, generally continued for at least three to six months, and often longer for patients with active cancer or a catheter that remains in place.1213
  • Catheter removal, when appropriate. If a central line or PICC caused the clot and is no longer medically necessary, a provider may recommend removing it, usually after anticoagulation has started.13
  • Catheter-directed thrombolysis. For larger, more severe or rapidly worsening clots, especially in younger patients with primary UEDVT, doctors may deliver clot-dissolving medication directly into the vein.14
  • Thoracic outlet decompression surgery. For patients with Paget-Schroetter syndrome, surgery to remove the first rib and relieve compression at the thoracic outlet is often recommended after initial thrombolysis and anticoagulation, since the underlying anatomical compression otherwise makes re-clotting more likely.514
  • Compression sleeves and arm elevation to help manage swelling and discomfort during recovery.
Most upper extremity DVTs occur because of pressure, blockage or direct injury to the veins
Get the answers you need

Frequently asked questions about upper extremity DVT

To identify whether a patient is ‘at-risk,’ healthcare professionals should conduct a VTE risk assessment, which is tool or questionnaire that gathers information about a patient’s age, medical history, medications and specific lifestyle factors. Information is then used to discern a patient’s potential risk (e.g., high, moderate or low risk) for developing blood clots in the legs or lungs.

If you are admitted to a hospital and don’t receive an assessment, be proactive. Ask for one.

Yes. While upper extremity DVT is less common than leg DVT, it can lead to serious complications, including pulmonary embolism and long-term arm swelling from post-thrombotic syndrome. Any sudden arm swelling, pain, discoloration or breathing difficulty should be evaluated right away.117

While upper extremity DVT is less common than leg DVT, it can lead to serious complications, including pulmonary embolism and long-term arm swelling from post-thrombotic syndrome. Any sudden arm swelling, pain, discoloration or breathing difficulty should be evaluated right away.117 

Learn more about cancer-associated thrombosis.

Paget-Schroetter syndrome, also called effort thrombosis, is a form of primary upper extremity DVT caused by repetitive or strenuous arm activity compressing the subclavian vein at the thoracic outlet. It most often affects young, active people such as swimmers, weightlifters and throwing athletes.45

Most patients are treated with anticoagulation for at least three to six months, sometimes longer if a catheter remains in place or cancer is present. Symptoms often improve within days to weeks of starting treatment, though some patients experience longer-term arm swelling or discomfort.1217

Learn about cancer-associated thrombosis.

Yes. A piece of the clot can break off and travel to the lungs. Reported rates vary across studies, but PE is a recognized and potentially life-threatening complication of upper extremity DVT, so sudden shortness of breath, chest pain or a rapid heartbeat after a diagnosed or suspected arm clot warrants emergency care.1516

Learn more about upper-extremity DVT from the ISTH

Research on Upper-Extremity DVT from the International Society on Thrombosis and Haemostasis (ISTH)

“The upper extremity postthrombotic syndrome score: an international Delphi consensus study to determine the score’s functional disability component“ – Res Pract Thromb Haemost. 2023. doi: 10.1016/j.rpth.2023.100051 

“Postthrombotic syndrome following upper extremity deep vein thrombosis in children“ – Res Pract Thromb Haemost. 2023. doi: 10.1016/j.rpth.2023.100094 

“A Single Center Retrospective Cohort Study Comparing Different Anticoagulants for the Treatment of Catheter-Related Thrombosis of the Upper Extremities in Women With Gynecologic and Breast Cancer“ – J Thromb Haemost. 2024. doi: 10.1016/j.jtha.2023.11.017 

“Functional impact of pediatric postthrombotic syndrome“ – J Thromb Haemost. 2023. doi: 10.1016/j.jtha.2023.01.004 

“Post-thrombotic syndrome after upper extremity deep vein thrombosis: An international Delphi consensus study“ – J Thromb Haemost. 2022. doi: 10.1111/jth.15767 []

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