TY - JOUR
T1 - Outcome of anticoagulation in isolated distal deep vein thrombosis compared to proximal deep venous thrombosis
AU - Vlazny, Danielle T.
AU - Pasha, Ahmed K.
AU - Kuczmik, Wiktoria
AU - Wysokinski, Waldemar E.
AU - Bartlett, Matthew
AU - Houghton, Damon
AU - Casanegra, Ana I.
AU - Daniels, Paul
AU - Froehling, David A.
AU - White, Launia J.
AU - Hodge, David O.
AU - McBane, Robert D.
N1 - Publisher Copyright:
© 2021 International Society on Thrombosis and Haemostasis
PY - 2021/9
Y1 - 2021/9
N2 - Background: Isolated, distal deep vein thrombosis (IDDVT) is thought to have low rates of propagation, embolization, and recurrence compared with proximal DVT (PDVT), but the data are limited. Objectives: The objective of this study was to assess outcomes among patients with IDDVT compared with PDVT. Patients/Methods: Consecutive patients with ultrasound-confirmed acute DVT (March 1, 2013–August 1, 2020) were identified by reviewing the Mayo Clinic Gonda Vascular Center and VTE Registry databases. Patients were divided into two groups depending on the DVT location (isolated, distal vs. proximal DVT). Outcomes including venous thromboembolism (VTE) recurrence, major bleeding, and death were compared by thrombus location and anticoagulant therapy, warfarin vs. direct oral anticoagulant (DOAC). Results: Isolated, distal deep vein thrombosis (n = 746) was more often associated with recent surgery, major trauma, or confinement (p <.001), whereas patients with PDVT (n = 1176) were more frequently unprovoked, had a prior history of VTE, or active cancer (p <.001). There was no overall difference in VTE recurrence or major bleeding between groups during follow-up. Patients with IDDVT had a higher death rate at 3 months (p =.001) and when propensity scored for cancer (p =.003). Independent predictors of mortality included warfarin (vs. DOAC) therapy, increasing age, and active cancer. DOAC therapy resulted in lower VTE recurrence, major bleeding, and death rates in both groups. Conclusion: Outcomes of IDDVT including VTE recurrence and bleeding rates were similar to PDVT despite higher early mortality rates. Outcomes for both groups were positively influenced by the use of DOACs.
AB - Background: Isolated, distal deep vein thrombosis (IDDVT) is thought to have low rates of propagation, embolization, and recurrence compared with proximal DVT (PDVT), but the data are limited. Objectives: The objective of this study was to assess outcomes among patients with IDDVT compared with PDVT. Patients/Methods: Consecutive patients with ultrasound-confirmed acute DVT (March 1, 2013–August 1, 2020) were identified by reviewing the Mayo Clinic Gonda Vascular Center and VTE Registry databases. Patients were divided into two groups depending on the DVT location (isolated, distal vs. proximal DVT). Outcomes including venous thromboembolism (VTE) recurrence, major bleeding, and death were compared by thrombus location and anticoagulant therapy, warfarin vs. direct oral anticoagulant (DOAC). Results: Isolated, distal deep vein thrombosis (n = 746) was more often associated with recent surgery, major trauma, or confinement (p <.001), whereas patients with PDVT (n = 1176) were more frequently unprovoked, had a prior history of VTE, or active cancer (p <.001). There was no overall difference in VTE recurrence or major bleeding between groups during follow-up. Patients with IDDVT had a higher death rate at 3 months (p =.001) and when propensity scored for cancer (p =.003). Independent predictors of mortality included warfarin (vs. DOAC) therapy, increasing age, and active cancer. DOAC therapy resulted in lower VTE recurrence, major bleeding, and death rates in both groups. Conclusion: Outcomes of IDDVT including VTE recurrence and bleeding rates were similar to PDVT despite higher early mortality rates. Outcomes for both groups were positively influenced by the use of DOACs.
KW - anticoagulation
KW - bleeding
KW - direct oral anticoagulant
KW - isolated distal deep vein thrombosis
KW - proximal deep vein thrombosis
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U2 - 10.1111/jth.15416
DO - 10.1111/jth.15416
M3 - Article
C2 - 34060224
AN - SCOPUS:85111136884
SN - 1538-7933
VL - 19
SP - 2206
EP - 2215
JO - Journal of Thrombosis and Haemostasis
JF - Journal of Thrombosis and Haemostasis
IS - 9
ER -