Compared to VKAs, NOAs are not only effective in treating VTE but also safer in terms of bleeding, thereby conferring clinical benefit. Their safety and efficacy was confirmed further in secondary prevention trials.

BackgroundThe treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse e ects of anticoagulation. ObjectivesTo assess the e ects of di erent treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. Selection criteriaRandomised controlled trials (RCTs) for the treatment of distal DVT. Data collection and analysisTwo review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-e ect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. Main resultsWe identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for di erent time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatmentAnticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compared with participants receiving no anticoagulation (RR 0.34, 95% CI 0.15 to 0.77; 5 studies, 496 participants; I 2 = 3%; high-certainty evidence), and reduced the risk of Treatment of distal deep vein thrombosis (Review)

Combined intermittent pneumatic leg compression and pharmacological prophylaxis for prevention of venous thromboembolism (Review)

BackgroundThe treatment of distal (below the knee) deep vein thrombosis (DVT) is not clearly established. Distal DVT can either be treated with anticoagulation, or monitored with close follow-up to detect progression to the proximal veins (above the knee), which requires anticoagulation. Proponents of this monitoring strategy base their decision to withhold anticoagulation on the fact that progression is rare and most people can be spared from potential bleeding and other adverse e ects of anticoagulation. ObjectivesTo assess the e ects of di erent treatment interventions for people with distal (below the knee) deep vein thrombosis (DVT). Search methodsThe Cochrane Vascular Information Specialist searched the Cochrane Vascular Specialised Register, CENTRAL, MEDLINE, Embase and CINAHL databases and World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov trials registers to 12 February 2019. We also undertook reference checking to identify additional studies. Selection criteriaRandomised controlled trials (RCTs) for the treatment of distal DVT. Data collection and analysisTwo review authors independently selected trials and extracted data. We resolved disagreements by discussion. Primary outcomes of interest were recurrence of venous thromboembolism (VTE), DVT and major bleeding and follow up ranged from three months to two years. We performed fixed-e ect model meta-analyses with risk ratio (RRs) and 95% confidence intervals (CIs). We assessed the certainty of the evidence using GRADE. Main resultsWe identified eight RCTs reporting on 1239 participants. Five trials randomised participants to anticoagulation for up to three months versus no anticoagulation. Three trials compared anticoagulation treatment for di erent time periods. Anticoagulant compared to no intervention or placebo for distal DVT treatmentAnticoagulation with a vitamin K antagonist (VKA) reduced the risk of recurrent VTE during follow-up compared with participants receiving no anticoagulation (RR 0.34, 95% CI 0.15 to 0.77; 5 studies, 496 participants; I 2 = 3%; high-certainty evidence), and reduced the risk of Treatment of distal deep vein thrombosis (Review)

intra-arterial thrombolysis for thromboembolic lower extremity arterial occlusions between January 2004 and May 2013. All patients were treated on a standard surgical ward. Endpoints were incidence of bleeding complications, duration of thrombolysis, angiographic patency rate, 30-day mortality rate, and amputation-free rate at 6 months. Results: Of the 171 cases analyzed, 129 cases underwent low-dose thrombolysis and 42 underwent high-dose thrombolysis. No major bleeding complications occurred in the low-dose group versus 5% in the high-dose group (p ¼ .01). The median duration of thrombolysis was 67 hours (4e304 hours) in the low-dose and 49 hours (2e171 hours) in the highdose group (p ¼ .027). Angiographic patency was restored in 67% of the cases in the low-dose group versus 79% of the high-dose group (p ¼ .17). The 30-day mortality rates were 1% in the low-dose versus 5% in the high-dose group (p ¼ .09). However, this higher mortality rate was not related to bleeding complications. Major amputation-free rates at 6 months were 81% in the low-dose group and 88% in the high-dose group (p ¼ .22). Conclusions: Based on this data series, low-dose thrombolysis for thromboembolic lower extremity arterial occlusions is as effective as highdose thrombolysis; however, the risk of major bleeding complications is substantially lower when using low-dose thrombolysis.