The Association Between Pulmonary Embolism and Deep Vein Thrombosis in the Upper or Lower Extremities in Neurocritical Care Patients.

Introduction: Patients in the neurological intensive care unit (ICU) are at an increased risk of venous thromboembolism (VTE). Anticoagulation is often indicated because deep venous thrombosis (DVT) can develop into pulmonary embolism (PE). However, anticoagulation also increases the risk of intracranial bleeding. Physicians must weigh the opposing risks carefully. It is commonly believed that upper extremity DVT (UEDVT) is less likely to develop into PE as compared to lower extremity DVT (LEDVT), but this lacks evidence, and our study investigates its validity.

Methods: Retrospective review of patients admitted to a neurological ICU from 2017 to 2022 and developed VTE.

Results: We reviewed 2,891 patients and 97 patients met study criteria. VTE occurred in 3.55% of patients, DVT in 2.63%, and PE in 0.96%. Of the recorded DVTs, 52.3% were in the upper extremities, 42.3% in the lower extremities, and 6.4% in both. PE rate was not significantly different in patients with UEDVT than in those with LEDVT (p = 0.233). Cather-associated DVT was more common in the upper extremities (p=0.002), but the PE rate was no different in catheter-associated DVT than non-catheter-associated DVT (p=0.193). The proportion of patients treated with therapeutic anticoagulation was not significantly different between patients with UEDVT alone and those with LEDVT (p=1.000).

Conclusion: In this sample of neurocritical care patients, the coexistence of DVT and PE did not differ in patients with upper versus lower extremity DVT. This should be considered in the neurocritical care unit when deciding whether to treat patients with DVT with anticoagulants.