Abstract
Background Isolated distal deep vein thromboses (IDDVT) are frequently diagnosed; however, their natural history and real risk of complications are still uncertain. Though treatment is still not well standardized, international guidelines recommend no more than 3 months of anticoagulation therapy. We investigated how Italian clinicians treat IDDVT patients in their real life in our country. Methods Baseline characteristics and clinical history of the patients enrolled in the prospective, observational, multicenter START-Register for a first IDDVT or proximal DVT (PDVT) were analyzed. Results Overall, 412 IDDVT patients were significantly younger, with better renal function, and more frequent major transient risk factors, when compared with 1,173 PDVT patients. The anticoagulation duration was >180 days in 52.7% of IDDVT patients (70.7% in PDVT). During treatment, bleeding occurred in 5.6 and 2.8% patient-years in IDDVT and PDVT, respectively ( p = 0082). Bleeding was more frequent in IDDVT than PDVT patients treated with warfarin (6.8 vs. 3.2 patient-years, p = 0.0228, respectively). Thrombotic complications occurred in 1.1 and 2.4% patient-years in IDDVT and PDVT patients, respectively. Analyzing together the two groups, 66.1% of bleeds and 86.1% thrombotic complications occurred after 90 days anticoagulation treatment. Conclusion The large majority of IDDVT patients received anticoagulation for more than 3 months. Most bleeding and thrombotic complications occurred after the first 90 days of anticoagulation therapy. These results indicate that an extended anticoagulation beyond 90 days in IDDVT patients is associated with increased risk of complications. Whether an extended treatment may lower recurrences after anticoagulation withdrawal should be assessed by specifically designed studies.
Highlights
Isolated distal deep vein thrombosis (IDDVT) generally refers to a thrombotic process that affects one or more of the deep calf veins but does not involve the popliteal or more proximal veins (PDVT)
Most bleeding and thrombotic complications occurred after the first 90 days of anticoagulation therapy. These results indicate that an extended anticoagulation beyond 90 days in IDDVT patients is associated with increased risk of complications
After excluding 1,966 patients (492 for thrombosis in different sites, 54 because the site of the event was not reported, and 1,420 because the event was a PE), 412 patients with IDDVT were analyzed and compared with the 1,173 with proximal DVT (PDVT) who were enrolled in the START-Register by 51 clinical centers which on average included 26 patients
Summary
Isolated distal deep vein thrombosis (IDDVT) generally refers to a thrombotic process that affects one or more of the deep calf veins (either axial or muscular) but does not involve the popliteal or more proximal veins (PDVT). Once IDDVTs are diagnosed, their optimal treatment is far from being standardized and longterm clinical outcomes unclear.. Once IDDVTs are diagnosed, their optimal treatment is far from being standardized and longterm clinical outcomes unclear.3 For this disease, heparin or derivatives (especially low molecular weight heparin [LMWH]), vitamin-K antagonists (VKAs), and direct oral anticoagulants (DOACs) can be used for therapy. Optimal treatment has still not been adequately standardized: anticoagulant of choice, appropriate dosing, and duration of treatment are still a matter of discussion This state of affairs, in large part, can be put down to a general lack of interest by researchers in the disease, as witness the literature which has been persistently much less than that on proximal DVT or pulmonary embolism.. We investigated how Italian clinicians treat IDDVT patients in their real life in our country
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