Long-Term Symptoms after Spontaneous Clots in Upper Arm Veins

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The summary below is from the full report titled "Long-Term Sequelae of Spontaneous axillary–subclavian Venous Thrombosis." It is in the 5 October 1999 issue of Annals of Internal Medicine (volume 131, pages 510-513). The authors are E. Héron, O. Lozinguez, J. Emmerich, C. Laurian, and J.-N. Fiessinger.

What is the problem and what is known about it so far?

Spontaneous axillary–subclavian venous thrombosis is a condition where blood clots develop in the veins of the upper arm area without an obvious reason such as injury to the arm. Some people with this condition develop long-term pain and swelling of the arm. It is unclear whether treating the condition with medication to dissolve the clot (thrombolysis) decreases the chances of long-term symptoms compared to treatment only with medicine that makes the blood take longer to clot (anticoagulants). It is also unclear how many people with axillary–subclavian thrombosis actually have pain and disability over the long term.

Why did the researchers do this particular study?

The researchers did this study to find out how many people with axillary–subclavian thrombosis have symptoms in the years that follow.

Who was studied?

Fifty-six patients with axillary–subclavian thrombosis seen at a specialized center at a hospital in France. Most of the patients received medication to make the blood take longer to clot (anticoagulants). None had received medications to dissolve the clot (thrombolysis).

How was the study done?

The researchers asked the patients to complete a survey that asked whether they had symptoms, what the main symptom was, how bad the symptoms were, and whether patients had to change their activities because of the symptoms. The researchers also asked patients to have an ultrasound study to examine the veins of the arm.

What did the researchers find?

Fifty-four patients completed the survey and 49 had the ultrasound. Nearly half of the patients said that they had no significant symptoms, and 13% reported severe symptoms. Only one patient had to change his occupation because of symptoms, and 6 changed a sport activity. The ultrasound findings were not at all related to the presence of symptoms.

What were the limitations of the study?

The study was small, but because this is an uncommon condition large studies would be difficult to do. Not all of the patients had the ultrasound test. This study was not able to determine whether the type of original treatment for the clot was associated with long-term symptoms.

What are the implications of the study?

Most people with axillary–subclavian venous thrombosis do well over the long term. The results of the ultrasound did not help tell who will suffer symptoms in the years following the thrombosis.