Anticoagulation in patients with isolated distal deep vein thrombosis: a meta‐analysis

Abstract

Background The optimal management of patients with isolated distal deep vein thrombosis (IDDVT), concerning both the need for anticoagulation and its duration, is undefined. Objectives We performed a meta-analysis of randomized and cohort studies in patients with IDDVT to assess the clinical benefit of: (i) anticoagulation versus no anticoagulation; and (ii) anticoagulant treatment for 6 weeks versus for > 6 weeks. Methods The primary outcome of this analysis was recurrent venous thromboembolism (proximal propagation, recurrence of deep vein thrombosis, and pulmonary embolism). Data were pooled and compared by the use of odds ratio (OR) and 95% confidence interval (CI). Results A reduction in the rate of recurrent venous thromboembolism was observed in patients who received anticoagulation relative to those who did not receive anticoagulation (either therapeutic or prophylactic) (20 studies, 2936 patients; OR 0.50, 95% CI 0.31-0.79), without an increase in the risk of major bleeding (OR 0.64, 95% CI 0.15-2.73). The rate of pulmonary embolism was lower in anticoagulant-treated patients than in controls (15 studies, 1997 patients; OR 0.48, 95% CI 0.25-0.91). A lower rate of recurrent venous thromboembolism was observed in patients who received > 6 weeks of anticoagulant therapy than in those who received 6 weeks of anticoagulant therapy (four studies, 1136 patients; OR 0.39, 95% CI 0.17-0.90). Conclusions In patients with IDDVT, anticoagulation (both therapeutic and prophylactic) reduces the rate of recurrent venous thromboembolism and the incidence of pulmonary embolism as compared with no anticoagulation, without an increased risk of major bleeding. Anticoagulation for > 6 weeks should be preferred over shorter durations.

Long‐term risk of postthrombotic syndrome after symptomatic distal deep vein thrombosis: The CACTUS‐PTS study

“…As distal DVT is frequent and accounts for up to half of all lower limb DVT, this is an important knowledge gap. Furthermore, whether distal DVT needs to be treated with therapeutic anticoagulation is still debated and anticoagulant treatment is not routinely recommended in international guidelines . Thus, in clinical practice, not all patients with distal DVT are offered therapeutic anticoagulation, which could have an impact on their risk of developing future PTS.…”

Die Unterschenkelvenenthrombose – eine Erkrankung für Spezialisten

“…Zur Beantwortung der Fragen, welche therapeutische Relevanz ist der Antikoagulation einer distalen Venenthrombose zuzuordnen und die Dauer der Antikoagulation herauszuarbeiten hat Franco et al 2017 eine interessante Metaanalyse durchgeführt (26): In dieser Auswertung von randomisierten und Kohorten-Studien war der primärer Endpunkt eine Rezidiv-VTE, einschließlich proximaler TVT-Ausdehnung und LE. (26).…”

“…Zur Beantwortung der Fragen, welche therapeutische Relevanz ist der Antikoagulation einer distalen Venenthrombose zuzuordnen und die Dauer der Antikoagulation herauszuarbeiten hat Franco et al 2017 eine interessante Metaanalyse durchgeführt (26): In dieser Auswertung von randomisierten und Kohorten-Studien war der primärer Endpunkt eine Rezidiv-VTE, einschließlich proximaler TVT-Ausdehnung und LE. (26). Betrachtet man nur die 16 Studien mit therapeutischer Antikoagulation zur Frage der Notwendigkeit einer Antikoagulation bei der dTVT, so zeigte sich auch hierbei der Vorteil der Antikoagulation in der Verhinderung der VTE-Rezidive (6,5% vs. 12,4%).…”

“…Auch die Rate an Lungenem-bolien war bei antikoagulierten Patienten niedriger als in der Kontrollgruppe (1,4% vs. 2,4%) (▶ Abb. 3) (26).…”

Management of cancer-associated venous thromboembolism – a case-based practical approach

“…A recent metaanalysis, however, has suggested that anticoagulation for > 6 weeks is associated with an improved clinical outcome in patients with IDDVT [31]. Moreover, in IDDVT patients with active cancer, retrospective cohort studies have indicated a recurrence rate of up to 13.2 per 100 patient-years despite anticoagulation [32][33][34].…”