Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation?

Sule, Ashish Anil; Chin, Tay Jam; Handa, Pankaj; Earnest, Arul

doi:10.1055/s-0031-1278332

Cited by 21 publications

(29 citation statements)

References 19 publications

(13 reference statements)

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“…This may explain our result because early anticoagulation therapy improves the rate of recanalization in portal vein thrombosis [16]. Furthermore, in a prospective study of 51 patients with isolated symptomatic deep vein thrombosis, Sule et al [24] showed no difference in resolution of distal vein thrombosis between patients with anticoagulation and pa- tients without anticoagulation, confirming the hypothesis that a thrombosis located in a small-caliber vein has a low rate of recanalization with anticoagulation. However, it is likely that the statistical power of our study was too low to draw definite conclusions regarding anticoagulation.…”

Section: Ct Of Mesenteric Vein Thrombosissupporting

confidence: 73%

Acute Mesenteric Vein Thrombosis: Factors Associated With Evolution to Chronic Mesenteric Vein Thrombosis

Violi

Fournier

Durán

et al. 2014

American Journal of Roentgenology

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Section: Ct Of Mesenteric Vein Thrombosissupporting

confidence: 73%

Acute Mesenteric Vein Thrombosis: Factors Associated With Evolution to Chronic Mesenteric Vein Thrombosis

Violi

Fournier

Durán

et al. 2014

American Journal of Roentgenology

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“…Following TKA, subjects transitioned between the following major health states (Figure ): proximal DVT, PE, bleeding, PJI, or no postoperative complications. We focused on proximal (versus distal) DVT, because this type of DVT is more likely to manifest clinically . Each health state is associated with a unique health‐related QoL and cost.…”

Section: Methodsmentioning

confidence: 99%

Cost‐Effectiveness of Alternative Anticoagulation Strategies for Postoperative Management of Total Knee Arthroplasty Patients

Smith

Katz

Losina

2019

Arthritis Care & Research

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Objective. To evaluate the cost-effectiveness of prolonged (35-day) and standard-duration (14-day) anticoagulation therapy following total knee arthroplasty (TKA).Methods. Using Markov modeling, we assessed clinical and economic outcomes of 14-day and 35-day anticoagulation therapy following TKA with rivaroxaban, low molecular weight heparin (LMWH), fondaparinux, warfarin, and aspirin. Incidence of complications of TKA and anticoagulation therapy (deep vein thrombosis [DVT], pulmonary embolism [PE], prosthetic joint infection [PJI], and bleeding) were derived from published literature. Daily costs ranged from $1 (aspirin) to $43 (fondaparinux). Primary outcomes included quality-adjusted life years (QALYs), direct medical costs, and incremental cost-effectiveness ratios (ICERs) at 1 year post-TKA. The preferred regimen was the regimen with highest QALYs maintaining an ICER below the willingness-to-pay threshold ($100,000/QALY). We conducted probabilistic sensitivity analyses, varying complication incidence and anticoagulation efficacy, to evaluate the impact of parameter uncertainty on model results.Results. Aspirin resulted in the highest cumulative incidence of DVT and PE, while prolonged fondaparinux led to the largest reduction in DVT incidence (15% reduction compared to no prophylaxis). Despite differential bleeding rates (ranging from 3% to 6%), all strategies had similar incidence of PJI (1% to 2%). Prolonged rivaroxaban was the least costly strategy ($3,300 at 1 year post-TKA) and the preferred regimen in the base case. In sensitivity analyses, prolonged rivaroxaban and warfarin had similar likelihoods of being cost-effective.Conclusion. Extending postoperative anticoagulation therapy to 35 days increases QALYs compared to standard 14-day prophylaxis. Prolonged rivaroxaban and prolonged warfarin are most likely to be cost-effective post-TKA; the costs of fondaparinux and LMWH precluded their being preferred strategies.

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“…Of the 14 studies included, 6 were RCTs, 20-25 4 prospective cohort studies, [26][27][28][29] and 4 retrospective cohort studies. [30][31][32][33] Baseline characteristics of included studies and study outcomes are shown in ►Tables 1 and 2. Twelve of the studies exclusively included patients with isolated distal DVT.…”

Section: Included Studiesmentioning

confidence: 99%

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

Lim¹,

Ariyarajah

Oldmeadow

et al. 2017

Semin Thromb Hemost

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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.

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Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation?

Abstract: Distal DVT may not require treatment with anticoagulation. If leg symptoms worsen, or if there is an extension of distal DVT on the follow-up scan, treatment with anticoagulation is recommended.

Cited by 21 publications

References 19 publications

Acute Mesenteric Vein Thrombosis: Factors Associated With Evolution to Chronic Mesenteric Vein Thrombosis

Acute Mesenteric Vein Thrombosis: Factors Associated With Evolution to Chronic Mesenteric Vein Thrombosis

Cost‐Effectiveness of Alternative Anticoagulation Strategies for Postoperative Management of Total Knee Arthroplasty Patients

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

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