Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: Results from the OPTIMEV study

Abstract

There is a lack of consensus on the value of detecting and treating symptomatic isolated distal deep-vein thrombosis (DVT) of the lower limbs. In our study, we compared the risk factors and outcomes in patients with isolated symptomatic distal DVT with those with proximal symptomatic DVT. We analysed the data of patients with objectively confirmed symptomatic isolated DVT enrolled in the national (France), multicenter, prospective OPTIMEV study. This sub-study outcomes were recurrent venous thromboembolism, major bleeding and death at three months. Among the 6141 patients with suspicion of isolated DVT included between November 2004 and January 2006, DVT was confirmed in 1643 patients (26.8%). Isolated distal DVT was more frequent than proximal DVT (56.8% vs. 43.2%, respectively; p = 0.01). Isolated distal DVT was significantly more often associated with transient risk factors (recent surgery, recent plaster immobilisation, recent travel), whereas proximal DVT was significantly more associated with more chronic states (active cancer, congestive heart failure or respiratory insufficiency, age >75 years). Most patients (96.8%) with isolated distal DVT received anticoagulant therapies. There was no difference in the percentage of recurrent venous thromboembolism and major bleeding in patients with proximal DVT and isolated distal DVT. However, the mortality rate was significantly higher (p < 0.01) in patients with proximal DVT (8.0%) than in those with isolated distal DVT (4.4%). Symptomatic isolated distal DVT differs from symptomatic proximal DVT both in terms of risk factors and clinical outcome. Whether these differences should influence the clinical management of these two events remains to be determined.

Guidance for the treatment of deep vein thrombosis and pulmonary embolism

“…Use of anticoagulation for 10 or more days was similar (96.8 vs. 97.3 %, p = 0.24) between distal and proximal DVT although patients with distal DVT were less likely to be treated for 3 months (89.1 vs. 91.8 %, p < 0.001) or receive an IVC filter (0.7 vs. 1.8 %, p < 0.001) [ 75 ]. In the OPTIMEV study cohort, patients with distal and proximal DVT suffered recurrent VTE (17 of 787, 2.2 % vs. 15 of 598, 2.5 %) at similar rates (OR 0.8 [0.4–1.8]) [ 76 ]. In a prospective open randomized clinical trial, Lagerstedt et al found that patients with symptomatic distal DVT that received 5 days of heparin only had a much higher rate of progressive/recurrent thrombosis than patients who received heparin followed by 3 months of warfarin (8/28 vs. 0/23, p < 0.01).…”

Meta-analysis and suggested guidelines for prevention of venous thromboembolism (VTE) in foot and ankle surgery

“…This is lower than in general orthopaedic surgery where the rate of DVT is reported as 40–60 % [ 23 ], but similar to the incidence of DVT following knee arthroscopy which has been reported as 0.6 % when diagnosed clinically and up to 17.9 % when using radiography [ 31 , 60 ]. The consequences of asymptomatic below knee DVT and the importance of its prevention and treatment remains controversial and a systematic review of the treatment of below knee DVT’s concluded there was insufficient evidence to recommend treatment over mere surveillance [ 8 , 19 , 29 , 34 , 43 , 45 , 58 , 61 , 74 ].…”

The Clots in Legs Or sTockings after Stroke (CLOTS) 3 trial: a randomised controlled trial to determine whether or not intermittent pneumatic compression reduces the risk of post-stroke deep vein thrombosis and to estimate its cost-effectiveness

“…[23][24][25] Calf DVTs are the most frequent component of the cluster of VTE events used in previous trials of VTE prophylaxis, yet their detection with CDU is technically challenging and results are inconsistent. The ultrasound technicians and radiographers were mainly blinded in their assessment of our primary outcome.…”