Behnood Bikdeli1,2,3, César Caraballo2, Javier Trujillo-Santos4, Jean Philippe Galanaud5, Pierpaolo di Micco6, Vladimir Rosa7, Gemma Vidal Cusidó8, Sebastian Schellong9, Meritxell Mellado10, María Del Valle Morales11, Olga Gavín-Sebastián12, Lucia Mazzolai13, Harlan M Krumholz2,14,15, Manuel Monreal16,17,18. 1. Cardiovascular Medicine Division and the Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. 2. Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut. 3. Cardiovascular Research Foundation, New York, New York. 4. Department of Internal Medicine, Hospital General Universitario Santa Lucía, Cartagena, Murcia, Spain Universidad Católica San Antonio de Murcia, Murcia, Spain. 5. Department of Medicine, Sunnybrook Health Sciences Centre and University of Toronto, Toronto, Ontario, Canada. 6. Department of Internal Medicine and Emergency Room, Ospedale Buon Consiglio Fatebenefratelli, Naples, Italy. 7. Department of Internal Medicine, Hospital Universitario Virgen de Arrixaca, Murcia, Spain. 8. Department of Internal Medicine, Corporación Sanitaria Parc Taulí, Barcelona, Spain. 9. Department of Medical Clinic, Municipal Hospital of Dresden Friedrichstadt, Dresden, Germany. 10. Department of Angiology and Vascular Surgery, Hospital del Mar, Barcelona, Spain. 11. Department of Internal Medicine, Hospital del Tajo, Madrid, Spain. 12. Department of Haematology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain. 13. Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland. 14. Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut. 15. Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut. 16. Department of Internal Medicine, Hospital Germans Trias i Pujol, Badalona, Barcelona. 17. Universidad Autónoma de Barcelona, Barcelona, Spain. 18. Chair for the Study of Thromboembolic Disease, Faculty of Health Sciences, Universidad Católica San Antonio de Murcia, Spain.
Abstract
Importance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT. Design, Setting, and Participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection. Main Outcomes and Measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE. Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%). Conclusions and Relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.
Importance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT. Design, Setting, and Participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection. Main Outcomes and Measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE. Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy. Patients with IDDVT had lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%). Conclusions and Relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.
Authors: Behnood Bikdeli; David Jimenez; Mayra Hawkins; Salvador Ortíz; Paolo Prandoni; Benjamin Brenner; Hervé Decousus; Frederick A Masoudi; Javier Trujillo-Santos; Harlan M Krumholz; Manuel Monreal Journal: Thromb Haemost Date: 2018-01-05 Impact factor: 5.249
Authors: Frederick A Spencer; Aimee Kroll; Darleen Lessard; Cathy Emery; Alla V Glushchenko; Luigi Pacifico; George Reed; Joel M Gore; Robert J Goldberg Journal: J Thromb Thrombolysis Date: 2012-04 Impact factor: 2.300
Authors: J P Galanaud; S Quenet; K Rivron-Guillot; I Quere; J F Sanchez Muñoz-Torrero; C Tolosa; M Monreal Journal: J Thromb Haemost Date: 2009-09-28 Impact factor: 5.824
Authors: Walter Ageno; Lorenzo G Mantovani; Sylvia Haas; Reinhold Kreutz; Danja Monje; Jonas Schneider; Jörg-Peter Bugge; Martin Gebel; Alexander G G Turpie Journal: TH Open Date: 2019-03-26
Authors: Behnood Bikdeli; Mahesh V Madhavan; David Jimenez; Taylor Chuich; Isaac Dreyfus; Elissa Driggin; Caroline Der Nigoghossian; Walter Ageno; Mohammad Madjid; Yutao Guo; Liang V Tang; Yu Hu; Jay Giri; Mary Cushman; Isabelle Quéré; Evangelos P Dimakakos; C Michael Gibson; Giuseppe Lippi; Emmanuel J Favaloro; Jawed Fareed; Joseph A Caprini; Alfonso J Tafur; John R Burton; Dominic P Francese; Elizabeth Y Wang; Anna Falanga; Claire McLintock; Beverley J Hunt; Alex C Spyropoulos; Geoffrey D Barnes; John W Eikelboom; Ido Weinberg; Sam Schulman; Marc Carrier; Gregory Piazza; Joshua A Beckman; P Gabriel Steg; Gregg W Stone; Stephan Rosenkranz; Samuel Z Goldhaber; Sahil A Parikh; Manuel Monreal; Harlan M Krumholz; Stavros V Konstantinides; Jeffrey I Weitz; Gregory Y H Lip Journal: J Am Coll Cardiol Date: 2020-04-17 Impact factor: 24.094