Profile of Patients with Isolated Distal Deep Vein Thrombosis versus Proximal Deep Vein Thrombosis or Pulmonary Embolism: RE-COVERY DVT/PE Study

Abstract

Isolated distal deep vein thrombosis (IDDVT) is presumed to be more benign than proximal DVT (PDVT) or pulmonary embolism (PE), suggesting a need for different management approaches. This subgroup analysis of the RE-COVERY DVT/PE global, observational study investigated patient characteristics, hospitalization details, and anticoagulant therapy in patients with IDDVT in real-world settings in 34 countries enrolled from January 2016 to May 2017. Data were analyzed descriptively according to the type and location of the index venous thromboembolism (VTE): IDDVT, PDVT ± distal DVT (DDVT), and PE ± DVT. Of the 6,095 eligible patients, 323 with DVT located outside the lower limb and no PE were excluded. Of the remaining 5,772 patients, 17.6% had IDDVT, 39.9% had PDVT ± DDVT, and 42.5% had PE ± DVT. IDDVT patients were younger and had fewer risk factors for VTE than the other groups. Other comorbidities were less frequent in the IDDVT group, except for varicose veins, superficial thrombophlebitis, and venous insufficiency. IDDVT patients were less likely to be diagnosed in an emergency department (22.3 vs. 29.7% for PDVT ± DDVT and 45.4% for PE ± DVT) or hospitalized for VTE (29.2 vs. 48.5% for PDVT ± DDVT and 75.0% for PE ± DVT). At hospital discharge or 14 days after diagnosis (whichever was later), non–vitamin K antagonist oral anticoagulants were the most commonly used anticoagulants (55.6% for IDDVT, 54.7% for PDVT ± DDVT, and 52.8% for PE ± DVT). Although differences in patient characteristics, risk factors, and clinical management were identified, anticoagulant treatment of IDDVT was almost equal to that of PDVT or PE. Prospective studies should investigate whether, in a global perspective, this is an appropriate use of anticoagulants. Trial registration number ClinicalTrials.gov NCT02596230.

Rivaroxaban treatment for six weeks versus three months in patients with symptomatic isolated distal deep vein thrombosis: randomised controlled trial

“… 6 7 However, studies describing clinical practice patterns report that almost all patients with isolated distal DVT receive anticoagulant treatment, with a proportion similar to that of patients with proximal DVT or pulmonary embolism. 8 9 11 12 Furthermore, in a study comparing outcomes among patients with isolated distal DVT stratified by management strategy, recurrence rates were statistically significantly lower in patients receiving anticoagulants than in those managed with surveillance ultrasonography only, and the net clinical benefit, including major bleeding events, clearly favoured anticoagulant treatment. 13 The actual difference between the management of isolated distal DVT and proximal DVT or pulmonary embolism is the duration of treatment, which tends to be shorter, with many patients with isolated distal DVT treated for 4-6 weeks 3 5 14 and fewer patients with isolated distal DVT treated for more than three months compared with patients with proximal DVT.…”

“… 13 The actual difference between the management of isolated distal DVT and proximal DVT or pulmonary embolism is the duration of treatment, which tends to be shorter, with many patients with isolated distal DVT treated for 4-6 weeks 3 5 14 and fewer patients with isolated distal DVT treated for more than three months compared with patients with proximal DVT. 8 9 15 …”

Characteristics and Treatment Strategy of Isolated Calf Deep Venous Thrombosis after Fractures: A Review of Recent Literature

“…Theoretically, patients with ICDVT had a lower risk of recurrence than patients with proximal DVT 31 . A recent multicenter and observational study showed that cumulative VTE recurrence was 4.8 times higher in patients with proximal DVT than in patients with distal DVT after 5 years of follow‐up 32 . In addition, bilateral isolated DVT has a worse prognosis, with more frequent recurrence, higher mortality, and a more frequent association with malignant tumors 33 , 34 , 35 , 36 .…”

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“…Moving on to the adult population, Schellong et al are here reporting data on isolated distal DVT in comparison with proximal DVT from a registry study with 6,095 patients. 10 The investigators found differences in the demography and risk factors between patients with distal DVT compared with proximal DVT and/or PE. There were also differences in location of diagnosis and initial clinical management.…”