Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis

Galanaud, J.-P.; Sevestre, Marie‐Antoinette; Genty, Céline; Kahn, Susan R.; Pernod, Gilles; Rolland, Carole; Diard, A.; Dupas, S.; Jurus, C.; Diamand, Jean-Marc; Quéré, I.; Bosson, Jean‐Luc

doi:10.1111/jth.12512

Cited by 118 publications

(111 citation statements)

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“…Patients with bilateral DVT have a signifi cantly higher risk of death than those with unilateral DVT after three months of follow-up, regardless of the initial location of the thrombosis in the lower limbs [2,8,31]. Moreover, patients with more than one distal deep vein with thrombosis, unilaterally or bilaterally, could have a signifi cantly increased risk of VTE recurrence after three years of follow up [16]. These fi ndings suggest that the amount of thrombosis material is associated with the prognosis.…”

Section: Discussionmentioning

confidence: 99%

“…These fi ndings suggest that the amount of thrombosis material is associated with the prognosis. Compared with provoked isolated distal DVT, unprovoked DVT has a signifi cantly higher proximal progression rate after one month and a signifi cantly increased risk of VTE recurrence after three years [16,32].…”

Section: Discussionmentioning

confidence: 99%

“…However, t here is still a lack of strong evidence to support this, and controversies persist regarding the rate of proximal extension of ICMVT [13 -15]. ICMVT should r aise the same concerns as deep calf vein thrombosis since they have similar prognostic outcomes after three months of follow-up and a similar risk of venous thromboembolism (VTE) recurrence after three years of follow-up [2,16].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

Huang

Wang

et al. 2016

Vasa

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Summary:Background: Diverse treatment suggestions range from monitoring with duplex examinations to therapeutic anticoagulation (TA) for managing isolated calf muscle vein thrombosis (ICMVT). However, the small sample sizes and low-level evidence provided by most studies in the literature mean that the benefi ts of promising new treatment protocols are unclear. Hence, this meta-analysis is intended to assess the effi cacy and safety of TA for patients with ICMVT. Patients and methods: Articles comparing TA with no anticoagulation (NA) or no therapeutic anticoagulation (NTA) in patients with ICMVT were collected from PubMed, the Cochrane Library, EMBASE, and Web of Science. The risk ratio (RR) and 95 % confi dence interval (95 % CI) were generated for each outcome of interest. The data were pooled using a random-effects or fi xedeffects model to evaluate differences in outcomes between the TA and control groups. Results: Five of 377 initially identifi ed papers were included. One randomized controlled trial, one non-randomized controlled trial and three retrospective cohort studies (a total of 744 patients, 390 in the TA group and the remaining 354 in the NA or NTA group) were included in this meta-analysis. The occurrence of thrombosis progression was signifi cantly less frequent in those who received TA compared with those receiving NTA (RR = 0.33, 95 % CI 0.20 to 0.54, p < 0.01). The rate of complete recanalization was higher, albeit not signifi cantly, in the TA group than in the NTA group (RR = 1.96, 95 % CI 1.01 to 3.80, p = 0.05). None of the pooled outcomes were signifi cantly different when comparing the TA and NA groups. Conclusions: This study suggests that TA may result in a signifi cant reduction in the rate of thrombosis progression and a marginally signifi cant increase in the rate of complete recanalization for patients with ICMVT. Further studies are needed to confi rm these fi ndings and clarify whether the benefi ts of TA outweigh the potential harm.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

Huang

Wang

et al. 2016

Vasa

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“…Indeed, we believe that, in the absence of clear evidence from clinical trials and in line with international guidelines, distal DVT should not be systematically treated with anticoagulants [5]. Nevertheless, we also believe that the systematic detection of distal DVT is important, as it allows the identification of patients at risk of VTE recurrence and of cancer [2,6]. When all types of contralateral DVT were taken into account, the risk of unilateral contralateral DVT in our population was as high as 1.6%, with the upper limit of the confidence interval reaching 2.0% (i.e.…”

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confidence: 99%

“…Its protocol has been previously described and is available from ClinicalTrials.gov (registration number, NCT00670540) [2]. For this analysis we only included those patients with unilateral signs or symptoms of lower-limb DVT.…”

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confidence: 99%

Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?: comment

Galanaud

Sevestre

Genty

et al. 2015

Journal of Thrombosis and Haemostasis

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In cases of suspected deep vein thrombosis (DVT), different compression ultrasound (CUS) protocols are used, and the usefulness of systematically screening the asymptomatic contralateral leg is a matter of controversy. In a recent article, Le Gal et al. reported that unilateral whole-leg CUS detected the large majority of DVTs and that the number of contralateral CUS examinations needed (NCCN) to diagnose one case of DVT after a negative unilateral examination of the ipsilateral side was high [1]. The authors concluded that unilateral CUS was safe and less time-consuming and therefore preferable to bilateral CUS. However, their study was subjected to several limitations, as acknowledged by the authors themselves. It was a single-center study (carried out at a large university hospital) and was retrospective in design, limiting the extent to which the results can be generalized. Furthermore, information was also lacking about the outcomes of patients with bilateral and isolated contralateral DVT, who were considered DVT-free on the basis of unilateral examinations of the ipsilateral leg.To fill this gap we analyzed data from the OPTIMEV study, in order to assess the usefulness of bilateral CUS exploration in patients with suspected unilateral DVT, in terms of both diagnostic (to detect an unsuspected unilateral contralateral or bilateral DVT) and prognostic performances (to identify populations at higher risk of death or venous thromboembolism (VTE) recurrence).The OPTIMEV study is a large, French, multicenter, prospective, observational study of in-and outpatients referred for clinically suspected venous thromboembolism to vascular medicine physicians and followed-up for 3 years thereafter. Its protocol has been previously described and is available from ClinicalTrials.gov (registration number, NCT00670540) [2]. For this analysis we only included those patients with unilateral signs or symptoms of lower-limb DVT. Patients were excluded if (i) symptomatic lower-limb DVT was not suspected, (ii) they had bilateral signs or symptoms of DVT or (iii) they had clinically overt or confirmed thrombosis (i.e. superficial vein thrombosis and objectively confirmed PE). At inclusion all eligible patients underwent standardized bilateral whole-leg CUS examination by a vascular medicine physician. Positive cases and a random selection of controls (patients for whom VTE was ruled out with objective tests) were then followed up for 3 years. We defined 'ipsilateral DVT' as DVT occurring in a symptomatic leg and 'contralateral DVT' as a DVT occurring in the leg contralateral to that displaying symptoms.For the statistical analysis of the diagnostic performances of each CUS protocol, we recorded rates of DVT, their type and their location for each group. We also calculated (i) the NCCN to detect one proximal DVT and one DVT in patients without proximal DVT or without DVT in the symptomatic leg and (ii) predictors of contralateral DVT in patients with and without ipsilateral DVT, using a stepwise multivariate model including age, se...

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Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

et al. 2022

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IMPORTANCEInsufficient 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 RELEVANCEResults 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.

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Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis

Cited by 118 publications

References 34 publications

Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

Efficacy and safety of therapeutic anticoagulation for the treatment of isolated calf muscle vein thrombosis - a systematic review and meta-analysis

Is it useful to also image the asymptomatic leg in patients with suspected deep vein thrombosis?: comment

Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry

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