Upper limb DVT

DVT can occur in the upper limb although it is much less common than in the lower limb. It presents with similar symptoms (pain, swelling) and signs (increased circumference, warmth, venous prominence and tenderness) to lower limb DVT.

Risk factors for upper limb DVT include central venous catheters (CVC), malignancy, inherited/acquired thrombophilia, pacemakers and upper limb surgery and/or immobilisation.

The role of D-dimer assay in upper limb DVT is less clear although intuitively it should have similar performance to lower limb DVT. Definitive investigation includes venography or compression ultrasound.

Optimal duration of warfarin therapy is unknown but 3-6 months is associated with low risk of recurrence. Bridging therapy with LMWH is required for at least the first five days as with lower limb DVT.