Dual Cardiac Arrests Leading to Hypercoagulability and Extensive Upper Extremity Deep Vein Thrombosis: A Hematological Case Report

Abstract

Upper extremity (UE) deep vein thrombosis (DVT) is a rare yet significant complication that can occur following cardiac arrest (CA). CA initiates a prothrombotic state via various processes, including stasis, endothelial damage, and an impaired balance between thrombogenesis and fibrinolysis, which may contribute to UE DVT formation. Inadequate cardiopulmonary resuscitation (CPR) in the field may further exacerbate blood stasis and clot formation. This case report describes an 80-year-old male with a history of bladder cancer who experienced two cardiac arrest events and subsequently developed an extensive left UE DVT. Despite treatment with a heparin drip and other supportive measures, the patient's condition deteriorated, and he passed away on the tenth day of hospitalization. This case is the first to describe UE DVT post-CA. It underscores the importance of recognizing and proactively managing hypercoagulable states post-CA, which can lead to significant DVTs in atypical locations that may evolve into life-threatening conditions.

Keywords: acute dvt; blood hypercoagulability; deep vein thrombosis (dvt); hematology; hypercoagulability; out-of-hospital cardiac arrest; upper extremity dvt.

Figure 1. Tense and edematous left hand extending to the wrist, with ecchymosis of the distal digits.

Figure 2. Venous doppler of the upper extremity.

Occlusion of the distal upper arm and forearm radial [A], forearm basilic [B], forearm ulnar [C], mid-to-distal upper arm and forearm cephalic veins [D] by echolucent thrombi.