Risk Factors for Progression of Distal Deep Vein Thrombosis
Background:There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT t...
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| Published in | Circulation Journal Vol. 84; no. 10; pp. 1862 - 1865 |
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| Main Authors | , , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
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Japan
The Japanese Circulation Society
25.09.2020
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| Abstract | Background:There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy.Methods and Results:Among 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P<0.01), and D-dimer level >8µg/mL (P=0.01) were identified.Conclusions:It is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level. |
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| AbstractList | There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy.BACKGROUNDThere is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy.Among 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P<0.01), and D-dimer level >8µg/mL (P=0.01) were identified.METHODS AND RESULTSAmong 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P<0.01), and D-dimer level >8µg/mL (P=0.01) were identified.It is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level.CONCLUSIONSIt is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level. There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy. Among 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P<0.01), and D-dimer level >8µg/mL (P=0.01) were identified. It is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level. Background:There is insufficient evidence regarding the optimal treatment method for distal deep vein thrombosis (DVT), including indications for anticoagulation therapy. Treatment results of patients with distal DVT were evaluated to clarify the risk factors that result in extension of distal DVT to the proximal vein and indications for anticoagulation therapy.Methods and Results:Among 430 patients with DVT between January 2018 and December 2019, 253 were diagnosed with distal DVT; 41 patients who had already started anticoagulation therapy were excluded, and the remaining 212 were included as study subjects. Anticoagulation therapy was not started immediately; conservative treatment with compression stockings was performed. Ultrasonography after 2 weeks revealed thrombus disappearance in 39 patients (21%), and thrombus reduction in 38 patients (20%). In contrast, extension of thrombus to the proximal vein was noted in 12 patients (6.3%) and anticoagulation therapy was commenced. After 3 months, the thrombus had disappeared in 75 patients (52%). No patient developed pulmonary thromboembolism during follow-up. With respect to the risk factors for extension to proximal vein during conservative treatment, active cancer (P=0.03), prolonged bed rest (P<0.01), and D-dimer level >8µg/mL (P=0.01) were identified.Conclusions:It is reasonable to consider anticoagulation therapy in distal DVT patients with active cancer, prolonged bed rest or high D-dimer level. |
| Author | Araki, Haruna Yakuwa, Kazuki Onishi, Yoshihiko Tadokoro, Yuki Miyamoto, Takashi Matsushiro, Takuya Kitamura, Tadashi Miyaji, Kagami Ohkubo, Hirotoki Fujioka, Shunichiro Mishima, Toshiaki Torii, Shinzo |
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| Cites_doi | 10.1016/j.jvs.2010.05.094 10.1160/TH15-06-0452 10.1503/cmaj.050051 10.1007/s00776-008-1264-0 10.1111/jth.12512 10.1111/jth.13336 10.1067/mva.2003.149 10.1253/circj.CJ-17-0445 10.1016/j.jvs.2011.07.088 10.1016/S2352-3026(16)30131-4 10.1378/chest.08-0658 |
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| References_xml | – reference: 5. Sartori M, Cosmi B. Anticoagulant therapy for symptomatic calf deep vein thrombosis. Lancet Haematol 2016; 3: e556–e562. – reference: 9. Yamashita Y, Shiomi H, Morimoto T, Yoneda T, Yamada C, Makiyama T, et al. Asymptomatic lower extremity deep vein thrombosis. Circ J 2017; 81: 1936–1944. – reference: 6. Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. Can Med Assoc J 2005; 173: 489–495. – reference: 7. Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA, et al. Categorization of patients as having provoked or unprovoked venous thromboembolism: Guidance from the SSC of ISTH. J Thromb Haemost 2016; 14: 1480–1483. – reference: 10. Fuji T, Ochi T, Niwa S, Fujita S. Prevention of postoperative venous thromboembolism in Japanese patients undergoing total hip or knee arthroplasty: Two randomized, double-blind, placebo-controlled studies with three dosage regimens of enoxaparin. J Orthop Sci 2008; 13: 442–451. – reference: 1. Philbrick JT, Becker DM. Calf deep venous thrombosis: A wolf in sheep’s clothing? Arch Intern Med 1988; 148: 2131–2138. – reference: 3. Schwarz T, Buschmann L, Beyer J, Halbritter K, Rastan A, Schellong S. Therapy of isolated calf muscle vein thrombosis: A randomized, controlled study. J Vasc Surg 2010; 52: 1246–1250. – reference: 2. MacDonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003; 37: 523–527. – reference: 8. Singh K, Yakoub D, Giangola P, DeCicca M, Patel CA, Marzouk F, et al. Early follow-up and treatment recommendations for isolated calf deep venous thrombosis. J Vasc Surg 2012; 55: 136–140. – reference: 11. Kearon C, Kahn SR, Agnelli G, Goldhaber S, Raskob GE, Comerota AJ. Antithrombotic therapy for venous thromboembolic disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th edn). Chest 2008; 133: 454S–545S. – reference: 12. van Es N, Di Nisio M, Bleker SM, Segers A, Mercuri MF, Schwocho L, et al. Edoxaban for treatment of venous thromboembolism in patients with cancer: Rationale and design of the Hokusai VTE-cancer study. Thromb Haemost 2015; 114: 1268–1276. – reference: 4. Galanaud JP, Sevestre MA, Genty C, Kahn SR, Pernod G, Rolland C, et al. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12: 436–443. – ident: 3 doi: 10.1016/j.jvs.2010.05.094 – ident: 12 doi: 10.1160/TH15-06-0452 – ident: 6 doi: 10.1503/cmaj.050051 – ident: 10 doi: 10.1007/s00776-008-1264-0 – ident: 1 – ident: 4 doi: 10.1111/jth.12512 – ident: 7 doi: 10.1111/jth.13336 – ident: 2 doi: 10.1067/mva.2003.149 – ident: 9 doi: 10.1253/circj.CJ-17-0445 – ident: 8 doi: 10.1016/j.jvs.2011.07.088 – ident: 5 doi: 10.1016/S2352-3026(16)30131-4 – ident: 11 doi: 10.1378/chest.08-0658 |
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| SubjectTerms | Aged Aged, 80 and over Anticoagulants - therapeutic use Anticoagulation therapy Bed rest Conservative Treatment - methods D-dimer levels Disease Progression Distal deep vein thrombosis Female Fibrin Fibrinogen Degradation Products - analysis Follow-Up Studies Humans Leg - blood supply Male Middle Aged Neoplasms - complications Pulmonary Embolism Retrospective Studies Risk Factors Sedentary Behavior Stockings, Compression Treatment Outcome Ultrasonography, Interventional - methods Venous Thrombosis - blood Venous Thrombosis - complications Venous Thrombosis - diagnostic imaging Venous Thrombosis - drug therapy |
| Title | Risk Factors for Progression of Distal Deep Vein Thrombosis |
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