Clinical Presentation and Outcomes of Patients With Cancer-Associated Isolated Distal Deep Vein Thrombosis

Abstract

PURPOSE Patients with isolated distal deep vein thrombosis (DVT) have lower rates of adverse outcomes (death, venous thromboembolism [VTE] recurrence or major bleeding) than those with proximal DVT. It is uncertain if such findings are also observed in patients with cancer. METHODS Using data from the international Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, we compared the risks of adverse outcomes at 90 days (adjusted odds ratio [aOR]; 95% CI) and 1 year (adjusted hazard ratio [aHR; 95% CI]) in 886 patients with cancer-associated distal DVT versus 5,196 patients with cancer-associated proximal DVT and 5,974 patients with non–cancer-associated distal DVT. RESULTS More than 90% of patients in each group were treated with anticoagulants for at least 90 days. At 90 days, the adjusted risks of death, VTE recurrence, or major bleeding were lower in patients with non–cancer-associated distal DVT than in patients with cancer-associated distal DVT (reference): aOR = 0.16 (0.11-0.22), aOR = 0.34 (0.22-0.54), and aOR = 0.47 (0.27-0.80), respectively. The results were similar at 1-year follow-up: aHR = 0.12 (0.09-0.15), aHR = 0.39 (0.28-0.55), and aHR = 0.51 (0.32-0.82), respectively. Risks of death, VTE recurrence, and major bleeding were not statistically different between patients with cancer-associated proximal versus distal DVT, both at 90 days: aOR = 1.11 (0.91-1.36), aOR = 1.10 (0.76-1.62), and aOR = 1.18 (0.76-1.83), respectively, and 1 year: aHR = 1.01 (0.89-1.15), aHR = 1.02 (0.76-1.35), and aHR = 1.10 (0.76-1.61), respectively. However, more patients with cancer-associated proximal DVT, compared with cancer-associated distal DVT, developed fatal pulmonary embolism (PE) during follow-up: The risk difference was 0.40% (95% CI, 0.23 to 0.58). CONCLUSION Cancer-associated distal DVT has serious and relatively comparable outcomes compared with cancer-associated proximal DVT. The lower risk of fatal PE from cancer-associated distal DVT needs further investigation.

Plantar vein thrombosis: 17-year longitudinal study of consecutive patients from a Swiss academic center

“…Other reports have suggested that a management strategy not relying on anticoagulants but rather on nonsteroidal anti-inflammatory drugs alone or combined with compression stockings could be an alternative approach [ [1] , [2] , [3] , 5 ]. Our results appear to be in line with recent findings indicating that the outcome after distal DVT secondary to major risk factors, notably cancer, may be as severe as that following proximal DVT [ 14 ].…”

Anticoagulation in Patients with Isolated Distal Deep Vein Thrombosis: Bringing the Puzzle Together

“…16 A recent study showed that, compared to IDDVT patients without cancer, those with cancer-associated IDDVT have 46% and 53% higher risks for recurrence and bleeding, respectively. 17 In this setting, guidelines suggest longer treatment duration (beyond 3 months) than that recommended for subjects with non-cancer-associated IDDVT (Figure). [7][8][9] Active cancer was, however, an exclusion criterium for most IDDVT treatment trials, and whether these patients may actually benefit from longer anticoagulation remained unproven.…”

“…16 A recent study showed that, compared with IDDVT patients without cancer, those with cancer-associated IDDVT have 46 and 53% higher risks for recurrence and bleeding, respectively. 17 In this setting, guidelines suggest longer treatment duration (beyond 3 months) than that recommended for subjects with noncancer-associated IDDVT (►Fig. 1).…”