Hospitalized Patients with Isolated Distal Deep Vein Thrombosis: Anticoagulation Therapy or Not?

Overview

Journal Thromb J

Publisher Biomed Central

Date 2022 Sep 13

PMID 36100922

Authors

Xiaolin Luo

Liying Zhang

Changchun Hou

Pengda Li

Shaofa Wu

Zebi Wang

Enpu Yang

Yun Cui

Ning Sun

Yang Yu

Zhixia An

Jun Jin

Zhexue Qin

Affiliations

Soon will be listed here.

Abstract

Background: Isolated distal deep vein thrombosis (IDDVT), a disease frequently detected in hospitalized patients, can progress to proximal deep vein thrombosis (PDVT) and pulmonary embolism (PE). Here, we evaluated the effects of anticoagulation in hospitalized IDDVT patients.

Methods: We conducted a retrospective study in our hospital and enrolled hospitalized IDDVT patients diagnosed by compression ultrasonography (CUS) from January to December 2020. Participants were divided into anticoagulation (AC) and non-anticoagulation (non-AC) groups. After propensity score matching (PSM), multivariate Cox regression analyses were performed to assess whether anticoagulation was associated with PDVT/PE, and all-cause mortality.

Results: A total of 426 IDDVT inpatients with CUS follow-up were screened from 1502 distal DVT patients and finally enrolled. The median age was 67 years with 51.4% males and 15.5% cancer patients. The median follow-up was 11.6 months. There were 288 and 138 patients treated with or without anticoagulants, respectively. Patients in the non-AC group had less body mass index and more comorbidities. Patients in the AC group were treated with rivaroxaban or dabigatran (52.1%), low molecular weight heparin (42.7%), and warfarin (5.2%). The PSM generated 111 pairs of well-matched IDDVT patients with or without anticoagulation. The Kaplan-Meier analysis demonstrated that neither the incidence of PDVT/PE (5.4% vs. 2.7%, log-rank p = 0.313) nor all-cause mortality (27.9% vs. 18.9%, log-rank p = 0.098) was significant different between groups. Anticoagulation was not associated with PDVT/PE and all-cause mortality in the multivariable Cox regression analyses using the matched cohorts. The main risk factors for all-cause mortality were age, malignancy history, BMI, sepsis, heart failure, and white blood cell (WBC) count.

Conclusions: In hospitalized IDDVT patients, the thrombosis extension rate to PDVT/PE was low. Anticoagulation did not reduce the incidence of thrombosis extension of IDDVT and was not associated with all-cause mortality.

Citing Articles

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References

Galanaud J, Sevestre M, Pernod G, Genty C, Richelet S, Kahn S . Long-term outcomes of cancer-related isolated distal deep vein thrombosis: the OPTIMEV study. J Thromb Haemost. 2017; 15(5):907-916. DOI: 10.1111/jth.13664. View

Schellong S, Goldhaber S, Weitz J, Ageno W, Bounameaux H, Turpie A . Isolated Distal Deep Vein Thrombosis: Perspectives from the GARFIELD-VTE Registry. Thromb Haemost. 2019; 119(10):1675-1685. DOI: 10.1055/s-0039-1693461. View

Johnson S, Stevens S, Woller S, Lake E, Donadini M, Cheng J . Risk of deep vein thrombosis following a single negative whole-leg compression ultrasound: a systematic review and meta-analysis. JAMA. 2010; 303(5):438-45. DOI: 10.1001/jama.2010.43. View

Gibson N, Schellong S, Kheir D, Beyer-Westendorf J, Gallus A, McRae S . Safety and sensitivity of two ultrasound strategies in patients with clinically suspected deep venous thrombosis: a prospective management study. J Thromb Haemost. 2009; 7(12):2035-41. DOI: 10.1111/j.1538-7836.2009.03635.x. View

Galanaud J, Sevestre M, Genty C, Kahn S, Pernod G, Rolland C . Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost. 2014; 12(4):436-43. DOI: 10.1111/jth.12512. View

Horner D, Hogg K, Body R, Nash M, Baglin T, Mackway-Jones K . The anticoagulation of calf thrombosis (ACT) project: results from the randomized controlled external pilot trial. Chest. 2014; 146(6):1468-1477. DOI: 10.1378/chest.14-0235. View

Righini M, Paris S, Le Gal G, Laroche J, Perrier A, Bounameaux H . Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost. 2006; 95(1):56-64. View

Konstantinides S, Meyer G, Becattini C, Bueno H, Geersing G, Harjola V . 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European.... Eur Respir J. 2019; 54(3). DOI: 10.1183/13993003.01647-2019. View

Utter G, Dhillon T, Salcedo E, Shouldice D, Reynolds C, Humphries M . Therapeutic Anticoagulation for Isolated Calf Deep Vein Thrombosis. JAMA Surg. 2016; 151(9):e161770. DOI: 10.1001/jamasurg.2016.1770. View

10.

Bendinelli C, Balogh Z . Postinjury thromboprophylaxis. Curr Opin Crit Care. 2008; 14(6):673-8. DOI: 10.1097/MCC.0b013e3283196538. View

11.

Vlazny D, Pasha A, Kuczmik W, Wysokinski W, Bartlett M, Houghton D . Outcome of anticoagulation in isolated distal deep vein thrombosis compared to proximal deep venous thrombosis. J Thromb Haemost. 2021; 19(9):2206-2215. DOI: 10.1111/jth.15416. View

12.

Bernardi E, Camporese G, Buller H, Siragusa S, Imberti D, Berchio A . Serial 2-point ultrasonography plus D-dimer vs whole-leg color-coded Doppler ultrasonography for diagnosing suspected symptomatic deep vein thrombosis: a randomized controlled trial. JAMA. 2008; 300(14):1653-9. DOI: 10.1001/jama.300.14.1653. View

13.

Nitta D, Mitani H, Ishimura R, Moriya M, Fujimoto Y, Ishiwata S . Deep vein thrombosis risk stratification. Int Heart J. 2013; 54(3):166-70. DOI: 10.1536/ihj.54.166. View

14.

Kearon C, Akl E, Ornelas J, Blaivas A, Jimenez D, Bounameaux H . Antithrombotic Therapy for VTE Disease: CHEST Guideline and Expert Panel Report. Chest. 2016; 149(2):315-352. DOI: 10.1016/j.chest.2015.11.026. View

15.

Austin P . Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med. 2009; 28(25):3083-107. PMC: 3472075. DOI: 10.1002/sim.3697. View

16.

Boddi M, Peris A . Deep Vein Thrombosis in Intensive Care. Adv Exp Med Biol. 2016; 906:167-181. DOI: 10.1007/5584_2016_114. View

17.

Huang F, Du C, Sun M, Ning B, Luo Y, An S . [Propensity score matching in SPSS]. Nan Fang Yi Ke Da Xue Xue Bao. 2015; 35(11):1597-601. View

18.

Samama M, Cohen A, Darmon J, Desjardins L, Eldor A, Janbon C . A comparison of enoxaparin with placebo for the prevention of venous thromboembolism in acutely ill medical patients. Prophylaxis in Medical Patients with Enoxaparin Study Group. N Engl J Med. 1999; 341(11):793-800. DOI: 10.1056/NEJM199909093411103. View

19.

Ochiai Y, Yamaguchi T, Komiyama C, Kodama T . Impact of Anticoagulation Therapy on the Risk of Pulmonary Embolism and Bleeding Events in Patients with Isolated Distal Deep-Vein Thrombosis. Int Heart J. 2021; 62(3):601-606. DOI: 10.1536/ihj.20-726. View

20.

Palareti G, Schellong S . Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost. 2011; 10(1):11-9. DOI: 10.1111/j.1538-7836.2011.04564.x. View