Controversies in the Diagnosis and Management of Distal Deep Vein Thrombosis

Robert‐Ebadi, Helia; Righini, Marc

doi:10.1007/978-3-319-65226-9_24

Cited by 1 publication

(2 citation statements)

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“…For example, distal DVTs may represent a more benign form of VTE, as they do not extend to the proximal veins in the majority of cases and are associated with a lower risk of recurrent VTE and death compared with their proximal counterparts. 47 48 As suggested by non-randomized and randomized studies, selected patients with distal DVT may not necessarily benefit from anticoagulation. 48 49 In patients with distal DVT at low risk of recurrence, the randomized CACTUS trial found no significant difference in the risk of VTE recurrence after 6 weeks, but a higher risk of clinically relevant bleeding in patients anticoagulated with nadroparin compared with those in the placebo group, although the study was terminated early due to recruitment difficulties.…”

Section: … and Risks And Benefits Of Anticoagulation Treatment Need T...mentioning

confidence: 99%

“…47 48 As suggested by non-randomized and randomized studies, selected patients with distal DVT may not necessarily benefit from anticoagulation. 48 49 In patients with distal DVT at low risk of recurrence, the randomized CACTUS trial found no significant difference in the risk of VTE recurrence after 6 weeks, but a higher risk of clinically relevant bleeding in patients anticoagulated with nadroparin compared with those in the placebo group, although the study was terminated early due to recruitment difficulties. 49 Overall, an individualized approach is suggested for treatment of distal DVT, with anticoagulation treatment of patients at high risk of extension or severe symptoms, and clinical surveillance with serial imaging (or alternatively, shorter treatment, or treatment at lower anticoagulation dose) 50 in low-risk patients without severe symptoms.…”

Section: … and Risks And Benefits Of Anticoagulation Treatment Need T...mentioning

confidence: 99%

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Subsegmental Pulmonary Embolism

Baumgartner,

Tritschler,

Aujesky

2023

Hamostaseologie

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Subsegmental pulmonary embolism (SSPE) is increasingly diagnosed with the growing use and technological advancements of multidetector computed tomography pulmonary angiography. Its diagnosis is challenging, and some presumed SSPE may actually represent imaging artifacts. Indirect evidence and results from small observational studies suggest that SSPE may be more benign than more proximal pulmonary embolism, and may thus not always require treatment. Therefore, guidelines suggest to consider a management strategy without anticoagulation in selected patients with SSPE at low risk of recurrent venous thromboembolism (VTE), in whom proximal deep vein thrombosis is excluded. Recently, a large prospective study among low-risk patients with SSPE who were left untreated showed a higher VTE recurrence risk than initially deemed acceptable by the investigators, and thus was prematurely interrupted after recruitment of 97% of the target population. However, the risk–benefit ratio of anticoagulation for low-risk patients with SSPE remains unclear, and results from randomized trials are needed to answer the question about their optimal management.

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Section: … and Risks And Benefits Of Anticoagulation Treatment Need T...mentioning

confidence: 99%