Blood Clot in Arm

July 8, 2013

Blood clots do not just occur in the legs a blood clot in arm can also happen, but they are in some ways a different animal.  Usually a blood clot in arm is not spontaneous in nature and there is almost always an underlying cause involved.  Probably the most common cause that I see on a regular basis in practice is a blood clot surrounding an IV line that has been placed.  Normally these clots are peripheral in nature and not in the deep venous system hence not a danger so we don’t normally treat these.  However, lines that are placed in the central veins like a central line or a PICC which stands for peripherally inserted central catheter can have clots associated with them.  Generally a foreign body in a low flow venous system portends a possibility of a clot taking place.  If you already have a disorder that makes you more prone to clotting of the venous system such as factor V leiden deficiency, prothrombin gene mutation, protein C, protein S or antithrombin deficiency then you are at increase risk of these happening.  Also a diagnosis of a systemic malignancy can make you more prone to clotting also known as a hypercoagulable state.

The most common symptom of a blood clot in the arm is swelling which is many times accompanied by pain, but it doesn’t have to be.  If swelling is in both arms then you could just be fluid overloaded.  Swelling in just one arm should definitely raise the suspicion that a clot is present.  Diagnosis is routinely made by doppler ultrasound and fortunately the arm vasculature is usually easily visualized by this modality.

So, should you treat a blood clot in the arm if you have one?  That really depends on a few factors.  One of them is the location of the clot in the arm whether it is in the deep vein system or not.  If it is indeed a deep venous thrombosis in the arm then where it is in the actual venous system is paramount.  A DVT in the more proximal system including the subclavian veins and even the brachial vein would qualify for treatment.  This is because these more proximal clots have a higher likelihood of breaking off and traveling to the lungs causing a blood clot in the lungs which is known more commonly as a pulmonary embolism or PE for short.   A pulmonary embolism is potentially life threatening and needs to be treated right away.   This is why treatment for a clot that is relatively proximal in the subclavian vein, superior vena cava or brachial vein should be considered for treatment.   There are many different ways to treat including using heparin, low molecular weight heparin also known as lovenox or enoxaparin, pradaxa (dabigatran) and xarelto (rivaroxiban).   The benefits and pitfalls of each blood clot treatment are discussed in a separate article.

In summary if you have symptoms of a blood clot in arm outlined below you should get tested with a doppler ultrasound and if you are found to have a blood clot use the guidelines above to decide on treatment options.  If medications are needed the many options for different anticoagulation agents are discussed in many places on this site.

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