Upper-extremity deep vein thrombosis associated with peripherally inserted central catheters in acute spinal cord injury: a report of 2 cases

Catheter-associated upper-extremity deep vein thrombosis (DVT) carries a 12% to 36% risk of pulmonary embolism (PE). Acute spinal cord injury (SCI) is a thrombophilic state resulting from altered fibrinolytic and platelet function and abnormal concentrations of clotting factors. Patients with SCI are frequently burdened with the classic risk factors of Virchow's triad including stasis, hypercoagulability, and intimal trauma. We present 2 patients with acute cervical SCI, both with venous thrombosis of the upper extremity associated with peripherally inserted central catheters. Both thrombotic events were insidious, and 1 patient developed a large PE. A high index of suspicion is necessary to make the diagnosis, and prompt aggressive anticoagulation is warranted absent contraindications. Little is known about the prevalence of and the morbidity associated with upper-extremity DVT in the SCI population. Our experience suggests that catheter-related, upper-extremity venous thromboembolism in SCI deserves further study.