Long‐term outcomes of cancer‐related isolated distal deep vein thrombosis: the OPTIMEV study

Abstract

Background Isolated distal deep vein thrombosis (iDDVT) (infra-popliteal DVT without pulmonary embolism [PE]) is a frequent event and, in the absence of cancer, is usually considered to be a minor form of venous thromboembolism (VTE). However, the clinical significance of cancer-related iDDVT is unknown. Methods Using data from the observational, prospective multicenter OPTIMEV cohort, we compared, at 3 years, the incidences of death, VTE recurrence and major bleeding in patients with cancer-related iDDVT with those in cancer patients with isolated proximal DVT (matched 1:1 on age and sex) and patients with iDDVT without cancer (matched 1:2 on age and sex). Results As compared with patients with cancer-related isolated proximal DVT (n = 92), those with cancer-related iDDVT (n = 92) had a similar risk of death (40.8% per patient-year (PY) vs. 38.3% per PY; aHR = 1.0, 95% CI[0.7-1.4]) and of major bleeding (3.8% per PY vs. 3.6% per PY, aCHR = 0.9 [0.3-3.2]) and a higher risk of VTE recurrence (5.4% per PY vs. 11.5% per PY; aCHR = 1.8 [0.7-4.5]). As compared with patients with iDDVT without cancer (n = 184), those with cancer-related iDDVT had a nine times higher risk of death (3.5% per PY vs. 38.3% per PY; aHR = 9.3 [5.5-15.9]), a higher risk of major bleeding (1.8% per PY vs. 3.6% per PY; aCHR = 2.0 [0.6-6.1]) and a higher risk of VTE recurrence (5.0% per PY vs. 11.5% per PY; aCHR = 2.0 [1.0-3.7]). The results remained similar in the subgroup of patients without history of VTE. Conclusion Patients with cancer-related iDDVT seem to have a prognosis that is similar to that of patients with cancer-related isolated proximal DVT and a dramatically poorer prognosis than patients with iDDVT without cancer. This underlines the high clinical significance of cancer-related iDDVT and the need for additional studies.

Clinical outcomes of isolated distal deep vein thrombosis versus proximal venous thromboembolism in cancer patients: The Cleveland Clinic experience

“…Second, in our study, we found a 1‐year VTE recurrence at 6% with an overall incidence rate of 6.5 recurrent VTEs per 100 patient‐years in patients with IDDVT and active cancer despite receiving anticoagulant treatment. This was comparable to the findings in two recent studies by Dentali et al and Galanaud et al in which they found a high risk of recurrent VTEs in patients with IDDVT and cancer . These studies together support initial treatment with anticoagulation in this population as the rate of VTE recurrence would presumably be much higher with a serial monitoring approach.…”

“…First, although the results of the CACTUS trial demonstrated a self‐limited course of IDDVTs in low‐risk patients, the optimal treatment of higher risk patients remained unknown . We confirmed findings in other studies that IDDVTs associated with cancer have an increased risk of VTE recurrence . Second, in our study, we found a 1‐year VTE recurrence at 6% with an overall incidence rate of 6.5 recurrent VTEs per 100 patient‐years in patients with IDDVT and active cancer despite receiving anticoagulant treatment.…”

“…These investigators reported that 99% of their study population received anticoagulation up front (mean treatment duration, 4.2 months) and there were 47 recurrent VTE events during the follow‐up period (incidence rate, 13.2 events per 100 patient‐years). Similarly, in a recent multicenter prospective cohort study, investigators from the OPTIMEV study found a higher risk of VTE recurrence, a nine times higher risk of death, and a higher risk of major bleeding in patients with cancer‐associated IDDVT compared to their noncancer counterparts . These investigators also reported a similar risk of death and major bleeding, and a higher risk of VTE recurrence in cancer‐associated IDDVT compared with cancer‐associated proximal VTE.…”

Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism

“…This observation indicates that cancer is the main risk factor to be considered for the development of adverse events after IDDVT. Consistently, the results of the two OPTIMEV sub-studies focusing on the 3-year rate of recurrence and death after cancer-associated DVT [24] and on subsequent cancer diagnosis after unprovoked DVT [13] suggested no differences between IDDVT and PDVT patients. It remains to be confirmed whether a more aggressive or diffused cancer is associated with a more proximal site of presenting DVT.…”

Rivaroxaban treatment of cancer‐associated venous thromboembolism: Memorial Sloan Kettering Cancer Center institutional experience

“…For CAT, we include any proximal or symptomatic distal lower extremity deep vein thrombosis (DVT) and/or incidental or symptomatic pulmonary embolism. Symptomatic distal DVTs were included, as these are routinely treated in cancer patients, and a recent study has confirmed that in cancer patients, distal DVTs have a comparable risk of VTE recurrence as proximal DVTs …”