Two years outcome of isolated distal deep vein thrombosis.
BACKGROUND
Isolated distal deep vein thrombosis (IDDVT) is frequently found in symptomatic outpatients, but its long term outcome is still uncertain.


OBJECTIVE
To assess IDDVT long term outcome and the impact of IDDVT characteristics on outcome.


METHODS
In a prospective, single center study we enrolled symptomatic outpatients in whom IDDVT was detected by whole-leg compression ultrasonography. Patients with provoked IDDVT were treated with low molecular weight heparins (LMWH) for 30 days while those with unprovoked IDDVT received with vitamin K antagonists (VKA) for three months. The primary end-point was the rate of the composite of pulmonary embolism (PE), proximal deep vein thrombosis (DVT), and IDDVT recurrence/extension during 24 month follow-up.


RESULTS
90 patients (age 61 ± 18, male 48.9%) were enrolled. Risk factors for thrombosis were reduced mobility (34.4%), obesity (25.3%), surgery (15.6%), and previous DVT (15.6%) and cancer in 8 patients (8.9%). Eighty-eight patients were treated (56 with LMWH and 32 with VKA). During follow-up (median 24 ± 2 months), 17 events were recorded, which included 3 PE (two in cancer patients), 4 proximal DVTs (one in cancer patient) and 10 IDDVT. Male sex (HR 4.73 CI95%: 1.55-14.5; p=0.006) and cancer (HR 5.47 CI95%: 1.76-17.6; p=0.003) were associated with a higher risk of complications, whereas IDDVT anatomical characteristics, anticoagulant therapy type, and provoked IDDVT were not.


CONCLUSIONS
The risk of recurrent venous thromboembolism after IDDVT may be relevant in male patients or in patients with active cancer. Larger studies are needed to address this issue.
Department of Angiology and Blood Coagulation "Marino Golinelli", S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy. Electronic address: michelangelo.sartori@aosp.bo.it.
Michelangelo
M
Sartori
Department of Angiology and Blood Coagulation "Marino Golinelli", S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
Ludovica
L
Migliaccio
Department of Angiology and Blood Coagulation "Marino Golinelli", S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
Elisabetta
E
Favaretto
Department of Angiology and Blood Coagulation "Marino Golinelli", S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
Gualtiero
G
Palareti
Department of Angiology and Blood Coagulation "Marino Golinelli", S. Orsola-Malpighi University Hospital, 40138 Bologna, Italy.
Benilde
B
Cosmi
D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000188:drug therapy*
D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight