A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

Abstract

Isolated distal deep vein thrombosis (DVT) represents an important clinical problem but there is no consensus regarding its management. The aim of this review was to evaluate the safety, efficacy, and shorter versus longer duration of anticoagulation in patients with isolated distal DVT. A systematic search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews. Studies reporting rates of symptomatic pulmonary embolism (PE), recurrent DVT, proximal extension, and/or major bleeding were included. Fourteen studies (six randomized controlled trials, eight cohorts) involving 2,918 patients met the eligibility criteria (with a total of 13 meeting criteria for the meta-analysis). Compared with no anticoagulation, anticoagulation was associated with a significant reduction in proximal extension (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.13–0.67; p < 0.004), recurrent DVT (OR: 0.16; 95% CI: 0.04–0.65; p = 0.01), and the composite end-point of proximal extension/PE (OR: 0.34; 95% CI: 0.16–0.72; p = 0.005); however, no significant differences in PE (OR: 0.47; 95% CI: 0.17–1.34; p = 0.16) or major bleeding (OR: 1.49; 95% CI: 0.33–6.86; p = 0.60) were observed. Anticoagulation for a longer duration (≥8 vs. ≤6 weeks) was associated with a significant reduction in proximal extension (OR: 0.23; 95% CI: 0.11–0.48; p < 0.001) but not for other outcomes.

Generation of a Predictive Clinical Model for Isolated Distal Deep Vein Thrombosis (ICMVT) Detection

“…Compared to proximal deep vein thrombosis (PDVT) patients and patients with pulmonary embolism (PE) in the lower extremities, ICMVT patients are more likely to undergo surgery or experience lower-extremity trauma, while PDVT Or PE patients are more likely to suffer from invasive cancer [ 38 ]. Here, the results are consistent with previous findings [ 38 , 40 , 41 ].…”

Thromboprophylactic Efficacy and Safety of Anticoagulants After Arthroscopic Knee Surgery: A Systematic Review and Meta-Analysis

“…39 In addition, it is worth mentioning that the ACCP 2012 and 2016 guidelines still recommend initial use of anticoagulation in patients with acute isolated distal DVT. 41,42 Besides, a recent meta-analysis favored the use of anticoagulants for isolated distal DVT, 43 revealing that anticoagulants significantly reduce the proximal extension of distal DVT. Collectively, it is not precise to neglect asymptomatic DVT and SDD, especially considering that the overall incidence of VTE in treatment group and control group were 1.8% and 6.3% respectively from our study.…”

Recommendations from the ICM-VTE: General

“…In a randomized controlled trial (RCT) of patients with symptomatic distal DVT presenting to the emergency room, Horner et al, found that the propagation including proximal DVT, and PE was 11% in the conservatively treated group vs. 0% in the anticoagulated group 753 . Similarly, in their systematic review of mainly nonsurgical patients, Lim et al, concluded that the risk for recurrence of DVT (odds ratio [OR] 0.16, p = 0.01) or the extension of the distal DVT in a proximal deep vein (OR 0.29; p < 0.004) was higher when a no treatment approach was performed compared with treatment with an anticoagulant drug 754 . Of note, the anticoagulation regimens in the included studies were heterogeneous in nature, including a variable combination of intravenous heparin, coumadin, or low-molecular-weight heparin (LMWH) (dalteparin, enoxaparin, or nadroparin).…”