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Jørgensen CT, Tavoly M, Førsund E, Pettersen HH, Tjønnfjord E, Ghanima W, Brækkan SK. Incidence of bleeding and recurrence in isolated distal deep vein thrombosis: findings from the Venous Thrombosis Registry in Østfold Hospital. J Thromb Haemost 2023; 21:2824-2832. [PMID: 37394122 DOI: 10.1016/j.jtha.2023.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Isolated distal deep vein thrombosis (IDDVT) is a common presentation of deep vein thrombosis. There are limited data on the long-term risk of recurrence after IDDVT. OBJECTIVES We aimed to determine the short- and long-term incidence of venous thrombosis (VTE) recurrence after cessation of anticoagulation and the 3-month incidence of bleeding during anticoagulant treatment in patients with IDDVT. METHODS Between January 2005 and May 2020, 475 patients with IDDVT and without active cancer were identified from the Venous Thrombosis Registry in Østfold Hospital, which is an ongoing registry of consecutive patients with VTE at Østfold Hospital, Norway. Major and clinically relevant, nonmajor bleeding as well as recurrent VTE were registered, and the cumulative incidences of these events were assessed. RESULTS The median age of the patients was 59 years (IQR, 48-72 years), 243 (51%) patients were women, and 175 events (36.8%) were classified as unprovoked. The 1-, 5-, and 10-year cumulative incidences of recurrent VTE were 5.6% (95% CI, 3.7-8.4), 14.7% (95% CI, 11.1-19.4), and 27.2% (95% CI, 21.1-34.5), respectively. The recurrence rates were higher for unprovoked IDDVT than for provoked IDDVT. Among the recurrent events, 18 (29%) were pulmonary embolisms and 21 (33%) were proximal deep vein thromboses. The 3-month cumulative incidence of major bleeding was 1.5% (95% CI, 0.7-3.1) overall and 0.8% (95% CI, 0.2-3.1) when restricted to patients treated with direct oral anticoagulants. CONCLUSION Despite initial treatment, the long-term risk of VTE recurrence after first-time IDDVT is high. The bleeding rates during anticoagulation, particularly with direct oral anticoagulants, were acceptably low.
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Affiliation(s)
- Camilla Tøvik Jørgensen
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Mazdak Tavoly
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway; Department of Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eli Førsund
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway
| | | | - Eirik Tjønnfjord
- Department of Emergency Medicine, Østfold Hospital, Sarpsborg, Norway
| | - Waleed Ghanima
- Department of Research, Østfold Hospital, Sarpsborg, Norway; Clinic of Internal Medicine, Østfold Hospital Sarpsborg, Sarpsborg, Norway; Department of Hematology, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Kufaas Brækkan
- Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Thrombosis Research Center, Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
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Mo M, Fukuda I, Nakamura M, Yamada N, Takayama M, Maeda H, Yamashita T, Ikeda T, Yamazaki T, Okumura Y, Hirayama A. Effectiveness and safety of the direct oral anticoagulant in acute distal deep vein thrombosis: From the prospective multicenter observational study, J'xactly, in Japan. Phlebology 2023; 38:4-15. [PMID: 36433754 DOI: 10.1177/02683555221141310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We assessed the effectiveness and safety of rivaroxaban in patients with isolated distal deep vein thrombosis (IDDVT). METHODS Symptomatic venous thromboembolism (VTE) and major bleeding were assessed. RESULTS Of 1016 patients with acute symptomatic/asymptomatic DVT and/or pulmonary embolism treated with rivaroxaban, 288 had IDDVT and 294 had proximal DVT (pDVT). The IDDVT group had fewer patients on the higher rivaroxaban dose (30 mg/day) (42.7% vs. 66.0%) and a shorter treatment duration (135.5 vs 369.5 days) than the pDVT group. VTE recurrence occurred in 14 and 11 patients with IDDVT and pDVT, respectively (2.89% vs. 2.29% per patient-year; p = 0.534). Major bleeding was less frequent in the IDDVT group (1.55% vs. 4.53% per patient-year; p = 0.044). Comparable effectiveness and safety were observed with 15 and 30 mg/day rivaroxaban in the IDDVT group. CONCLUSIONS Short-term, low-dose rivaroxaban seems safe and effective for IDDVT treatment.
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Affiliation(s)
- Makoto Mo
- Department of Cardiovascular Surgery, 73663Yokohama Minami Kyosai Hospital, Yokohama, Japan
| | - Ikuo Fukuda
- Department of Cardiology, Keimeikai Yokawa Hospital, Miki, Japan
| | | | - Norikazu Yamada
- Department of Cardiology, 38153Kuwana City Medical Center, Kuwana, Japan
| | - Morimasa Takayama
- Department of Cardiology, 26383Sakakibara Heart Institute, Fuchu, Japan
| | - Hideaki Maeda
- Division of Cardiovascular Surgery, 38113Nihon University School of Medicine, Tokyo, Japan
| | - Takeshi Yamashita
- Department of Cardiovascular Medicine, The Cardiovascular Institute, Tokyo, Japan
| | - Takanori Ikeda
- Department of Cardiovascular Medicine, 36591Toho University Faculty of Medicine, Tokyo, Japan
| | - Tsutomu Yamazaki
- Innovation and Research Support Center, 34804International University of Health and Welfare, Tokyo, Japan
| | - Yasuo Okumura
- Division of Cardiology, Department of Medicine, 38113Nihon University School of Medicine, Tokyo, Japan
| | - Atsushi Hirayama
- Department of Cardiology, 38420Osaka Police Hospital, Osaka, Japan
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Ogino Y, Ishigami T, Sato R, Nakahashi H, Minamimoto Y, Kimura Y, Okada K, Matsuzawa Y, Iwahashi N, Hibi K, Kosuge M, Ebina T, Ishikawa T, Tamura K, Kimura K. Direct Oral Anticoagulant Therapy for Isolated Distal Deep Vein Thrombosis Associated with Cancer in Routine Clinical Practice. J Clin Med 2021; 10:4648. [PMID: 34682770 DOI: 10.3390/jcm10204648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/30/2021] [Accepted: 10/08/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The efficacy and bleeding complications of direct oral anticoagulant (DOAC) therapy for isolated distal deep vein thrombosis (IDDVT) associated with cancer in routine clinical practice remain unclear. Moreover, prior studies on prolonged therapy for IDDVT are limited. METHODS This retrospective study enrolled 1641 consecutive patients with acute venous thromboembolism (VTE) who had received oral anticoagulant therapy, including warfarin or DOAC, between April 2014 and September 2018 in our institutions. In these patients, 200 patients with cancer-associated IDDVT were evaluated. RESULTS Mean follow-up period was 780 ± 593 days. Major bleeding and VTE recurrence were observed in 22 (11.0%) and 11 (5.5%) patients, respectively. In multivariate analysis, statistically significant factors correlated with major bleeding were advanced cancer stage, high performance status, stomach cancer, and gallbladder cancer; those correlated with all-cause death were advanced cancer stage, high performance status, liver dysfunction, pancreatic cancer, and major bleeding. Cumulative events of major bleeding and recurrence between patients with prolonged DOAC therapy (≥90 days) and those with nonprolonged therapy were not significantly different. CONCLUSIONS Preventing major bleeding is important because it is a significant risk factor for all-cause death. Major bleeding and recurrent events were comparable between prolonged and nonprolonged therapy.
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Vlazny DT, Pasha AK, Kuczmik W, Wysokinski WE, Bartlett M, Houghton D, Casanegra AI, Daniels P, Froehling DA, White LJ, Hodge DO, McBane RD. Outcome of anticoagulation in isolated distal deep vein thrombosis compared to proximal deep venous thrombosis. J Thromb Haemost 2021; 19:2206-2215. [PMID: 34060224 DOI: 10.1111/jth.15416] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 05/20/2021] [Accepted: 05/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Isolated, distal deep vein thrombosis (IDDVT) is thought to have low rates of propagation, embolization, and recurrence compared with proximal DVT (PDVT), but the data are limited. OBJECTIVES The objective of this study was to assess outcomes among patients with IDDVT compared with PDVT. PATIENTS/METHODS Consecutive patients with ultrasound-confirmed acute DVT (March 1, 2013-August 1, 2020) were identified by reviewing the Mayo Clinic Gonda Vascular Center and VTE Registry databases. Patients were divided into two groups depending on the DVT location (isolated, distal vs. proximal DVT). Outcomes including venous thromboembolism (VTE) recurrence, major bleeding, and death were compared by thrombus location and anticoagulant therapy, warfarin vs. direct oral anticoagulant (DOAC). RESULTS Isolated, distal deep vein thrombosis (n = 746) was more often associated with recent surgery, major trauma, or confinement (p < .001), whereas patients with PDVT (n = 1176) were more frequently unprovoked, had a prior history of VTE, or active cancer (p < .001). There was no overall difference in VTE recurrence or major bleeding between groups during follow-up. Patients with IDDVT had a higher death rate at 3 months (p = .001) and when propensity scored for cancer (p = .003). Independent predictors of mortality included warfarin (vs. DOAC) therapy, increasing age, and active cancer. DOAC therapy resulted in lower VTE recurrence, major bleeding, and death rates in both groups. CONCLUSION Outcomes of IDDVT including VTE recurrence and bleeding rates were similar to PDVT despite higher early mortality rates. Outcomes for both groups were positively influenced by the use of DOACs.
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Affiliation(s)
- Danielle T Vlazny
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Ahmed K Pasha
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | | | - Waldemar E Wysokinski
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | | | - Damon Houghton
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Ana I Casanegra
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Paul Daniels
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
| | - David A Froehling
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
| | - Launia J White
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Robert D McBane
- Gonda Vascular Center, Mayo Clinic, Rochester, MN, USA
- Cardiovascular Department, Mayo Clinic, Rochester, MN, USA
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Palareti G, Legnani C, Antonucci E, Testa S, Mastroiacovo D, Cosmi B, Poli D, Bucherini E, Dentali F, Fontanella A, Mumoli N, Imberti D, Falanga A, Ageno W, Pomero F. Management and Outcomes of Isolated Distal Deep Vein Thromboses: A Questionable Trend toward Long-Lasting Anticoagulation Treatment. Results from the START-Register. TH Open 2021; 5:e239-50. [PMID: 34263110 DOI: 10.1055/s-0041-1730038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/12/2021] [Indexed: 12/18/2022] Open
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.
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