title: Long-term outcomes of cancer-related isolated distal deep vein thrombosis: the OPTIMEV study.
abstract: Essentials Clinical significance of cancer-related isolated distal deep vein thrombosis (iDDVT) is unknown. We studied patients with iDDVT, with and without cancer, and proximal DVT with cancer. Cancer-related iDDVT patients have a much poorer prognosis than iDDVT patients without cancer. Cancer-related iDDVT patients have a similar prognosis to cancer-related proximal DVT patients.
  
  
  
  Background Isolated distal deep vein thrombosis (iDDVT) (infra-popliteal DVT without pulmonary embolism [PE]) is a frequent event and, in the absence of cancer, is usually considered to be a minor form of venous thromboembolism (VTE). However, the clinical significance of cancer-related iDDVT is unknown. Methods Using data from the observational, prospective multicenter OPTIMEV cohort, we compared, at 3 years, the incidences of death, VTE recurrence and major bleeding in patients with cancer-related iDDVT with those in cancer patients with isolated proximal DVT (matched 1:1 on age and sex) and patients with iDDVT without cancer (matched 1:2 on age and sex). Results As compared with patients with cancer-related isolated proximal DVT (n = 92), those with cancer-related iDDVT (n = 92) had a similar risk of death (40.8% per patient-year (PY) vs. 38.3% per PY; aHR = 1.0, 95% CI[0.7-1.4]) and of major bleeding (3.8% per PY vs. 3.6% per PY, aCHR = 0.9 [0.3-3.2]) and a higher risk of VTE recurrence (5.4% per PY vs. 11.5% per PY; aCHR = 1.8 [0.7-4.5]). As compared with patients with iDDVT without cancer (n = 184), those with cancer-related iDDVT had a nine times higher risk of death (3.5% per PY vs. 38.3% per PY; aHR = 9.3 [5.5-15.9]), a higher risk of major bleeding (1.8% per PY vs. 3.6% per PY; aCHR = 2.0 [0.6-6.1]) and a higher risk of VTE recurrence (5.0% per PY vs. 11.5% per PY; aCHR = 2.0 [1.0-3.7]). The results remained similar in the subgroup of patients without history of VTE. Conclusion Patients with cancer-related iDDVT seem to have a prognosis that is similar to that of patients with cancer-related isolated proximal DVT and a dramatically poorer prognosis than patients with iDDVT without cancer. This underlines the high clinical significance of cancer-related iDDVT and the need for additional studies.
authors.affiliation: Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, EA 2992, Montpellier University, Montpellier, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Galanaud
authors.affiliation: Department of Vascular Medicine, Amiens University Hospital, Amiens, France.
authors.forename: M-A
authors.initials: MA
authors.lastname: Sevestre
authors.affiliation: Department of Vascular Medicine, Grenoble-Alpes University Hospital, Grenoble, France.|Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Pernod
authors.affiliation: Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France.
authors.forename: C
authors.initials: C
authors.lastname: Genty
authors.affiliation: Department of Cardiology and Vascular Medicine, William Morey Hospital, Chalon sur Saone, France.
authors.forename: S
authors.initials: S
authors.lastname: Richelet
authors.affiliation: Department of Medicine, McGill University and Centre for Clinical Epidemiology, Jewish General Hospital, Montreal, QC, Canada.
authors.forename: S R
authors.initials: SR
authors.lastname: Kahn
authors.affiliation: Department of Vascular Medicine, Bordeaux University Hospital, Bordeaux, France.
authors.forename: C
authors.initials: C
authors.lastname: Boulon
authors.affiliation: Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France.
authors.forename: H
authors.initials: H
authors.lastname: Terrisse
authors.affiliation: Department of Internal Medicine and Clinical Investigation Centre, Montpellier University Hospital, EA 2992, Montpellier University, Montpellier, France.
authors.forename: I
authors.initials: I
authors.lastname: Quéré
authors.affiliation: Department of Public Health, University Grenoble Alpes, CNRS, Grenoble-Alpes University Hospital and TIMC-IMAG, Grenoble, France.
authors.forename: J-L
authors.initials: JL
authors.lastname: Bosson
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005602:France / Q000453:epidemiology; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011152:Popliteal Vein; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D020246:Venous Thrombosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality
keywords: Epidemiological studies; bleeding; cancer; death; deep vein thrombosis; recurrence