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

Abstract

Background A few studies have focused on the risk of recurrence after first acute isolated distal deep vein thrombosis (IDDVT) compared with proximal DVT (PDVT), whereas the incremental risk of death has never been explored beyond the first 3 years after acute event. Methods Our single-center cohort study included patients with first symptomatic acute PDVT or IDDVT. Patients were excluded if they had concomitant pulmonary embolism (PE) or prior venous thromboembolism. The primary outcomes were symptomatic objectively diagnosed recurrent PDVT or PE and all-cause death. Results In total, 4759 records were screened and 831 subjects included: 202 had symptomatic IDDVT and 629 had PDVT. The median age was 66 years and 50.5% were women. A total of 125 patients had recurrent PDVT or PE during 3175 patient-years of follow-up: 109 events occurred after PDVT (17.3%) and 16 after IDDVT (7.9%). Annual recurrence rates were 4.5% (95% confidence interval [CI], 3.7-5.4%) and 2.0% (95% CI, 1.1-3.2%), respectively, for an adjusted hazard ratio (aHR) for IDDVT patients of 0.32 (95% CI, 0.19-0.55). Death occurred in 263 patients (31.6% [95% CI, 28.6-34.9%]) during 5469 patient-years of follow-up for an overall annual incidence rate of 4.8% (95% CI, 4.2-5.4%). The mortality rate was 33.5% (n = 211) in PDVT patients and 25.7% (n = 52) in IDDVT patients. The long-term hazard of death appeared lower for IDDVT patients (aHR, 0.75 [95% CI, 0.55-1.02]), especially after unprovoked events (aHR, 0.58 [95% CI, 0.26-1.31]). Conclusions Compared with PDVT, IDDVT patients were at a lower risk of recurrent VTE. The risk of death appeared lower after IDDVT during a median follow-up of 7.6 years.

New guidelines from the Thrombosis and Haemostasis Society of Australia and New Zealand for the diagnosis and management of venous thromboembolism

“…Many risk factors for VTE recurrence have been identified, although few have a major effect (Box 10). Most clinical decisions can be made by assessing the following predictors of recurrence: unprovoked, non‐surgical provoking factor and persistent risk factors versus provoked by surgery; PE and proximal DVT versus distal DVT; prior VTE; and male sex …”

Current and future burden of venous thrombosis: Not simply predictable

“…For this purpose, an international cohort management study currently investigates the safety of withholding anticoagulants in these patients (NCT01455818).Although incidence data over time are limited, the increase in use of whole-leg ultrasound as opposed to the use of only proximal ultrasound has likely led to an increase in identification of distal deep vein thromboses. Although these can present with troublesome symptoms, distal deep vein thromboses are less burdensome than proximal deep vein thrombosis as they are associated with a lower recurrence and mortality rate 47,48. Whether patients (outside of special patient groups) with symptomatic distal deep vein thromboses benefit from anticoagulation therapy is currently debated 49,50.…”

Die Unterschenkelvenenthrombose – eine Erkrankung für Spezialisten

“…Frauen waren in der Gruppe mit dTVT überrepräsentiert (56,4% vs. 48,6% bei proximalen TVT), ebenso einige auslösende Faktoren (wie z.B. OP oder ein Trauma) (20).…”