Download PDF
CC BY-NC-ND 4.0 · Thromb Haemost 2019; 119(10): 1675-1685
DOI: 10.1055/s-0039-1693461
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Isolated Distal Deep Vein Thrombosis: Perspectives from the GARFIELD-VTE Registry

Sebastian M. Schellong
1   Medical Division 2, Municipal Hospital Dresden-Friedrichstadt, Dresden, Germany
,
Samuel Z. Goldhaber
2   Harvard Medical School, Harvard University, Boston, Massachusetts, United States
,
Jeffrey I. Weitz
3   Thrombosis and Atherosclerosis Research Institute, McMaster University, Hamilton, Ontario, Canada
,
Walter Ageno
4   Department of Medicine and Surgery, University of Insubria, Varese, Italy
,
Henri Bounameaux
5   Faculty of Medicine, University Hospitals of Geneva, Geneva, Switzerland
,
Alexander G. G. Turpie
6   McMaster University, Hamilton, Ontario, Canada
,
Pantep Angchaisuksiri
7   Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
,
Sylvia Haas
8   Department of Medicine, Technical University of Munich, Munich, Germany
,
Shinya Goto
9   Department of Medicine (Cardiology), Tokai University School of Medicine, Tokyo, Japan
,
Audrey Zaghdoun
10   Thrombosis Research Institute, London, United Kingdom
,
Alfredo Farjat
10   Thrombosis Research Institute, London, United Kingdom
,
Joern Dalsgaard Nielsen
11   Copenhagen University Hospital, Copenhagen, Denmark
,
Gloria Kayani
10   Thrombosis Research Institute, London, United Kingdom
,
Lorenzo G. Mantovani
12   University Degli Studi di Milano Bicocca, Milan, Italy
,
Paolo Prandoni
13   Arianna Foundation on Anticoagulation, Bologna, Italy
,
Ajay K. Kakkar
14   Thrombosis Research Institute, University College London, London, United Kingdom
› Author Affiliations Funding The GARFIELD-VTE registry is an independent academic research initiative sponsored by the Thrombosis Research Institute (London, UK) and supported by an unrestricted research grant from Bayer Pharma AG (Berlin, Germany).
Further Information

Publication History

03 January 2019

29 May 2019

Publication Date:
01 August 2019 (online)

    Permissions and Reprints

Corrected by:

ErratumThromb Haemost 2019; 119(10): e1-e1
DOI: 10.1055/s-0040-1702204

Abstract

Isolated distal deep vein thrombosis (IDDVT) represents up to half of all lower limb DVT. This study investigated treatment patterns and outcomes in 2,145 patients with IDDVT in comparison with those with proximal DVT (PDVT; n = 3,846) and pulmonary embolism (PE; n = 4,097) enrolled in the GARFIELD-VTE registry. IDDVT patients were more likely to have recently undergone surgery (14.6%) or experienced leg trauma (13.2%) than PDVT patients (11.0 and 8.7%, respectively) and PE patients (12.7 and 4.5%, respectively). Compared with IDDVT, patients with PDVT or PE were more likely to have active cancer (7.2% vs. 9.9% and 10.3%). However, influence of provoking factors on risk of recurrence in IDDVT remains controversial. Nearly all patients (IDDVT, PDVT, and PE) were given anticoagulant therapy. In IDDVT, PDVT, and PE groups the proportion of patients receiving anticoagulant therapy was 61.4, 73.9, and 81.1% at 6 months and 45.8, 54.7, and 61.9% at 12 months. Over 12 months, the incidence of all-cause mortality, cancer, and recurrence was significantly lower in IDDVT patients than PDVT patients (hazard ratio [HR], 0.61 [95% confidence interval [CI], 0.48–0.77]; sub-HR [sHR], 0.60 [95% CI, 0.39–0.93]; and sHR, 0.76 [95% CI, 0.60–0.97]). Likewise, risk of death and incident cancer was significantly (both p < 0.05) lower in patients with IDDVT compared with PE. This study reveals a global trend that most IDDVT patients as well as those with PDVT and PE are given anticoagulant therapy, in many cases for at least 12 months.

Keywords

deep vein thrombosis - isolated distal deep vein thrombosis - 12-month observational study - GARFIELD-VTE registry

Supplementary Material

 

  • References

  • 1 Piazza G, Goldhaber SZ. Physician alerts to prevent venous thromboembolism. J Thromb Thrombolysis 2010; 30 (01) 1-6
    CrossrefPubMedGoogle Scholar
  • 2 Stevens SM, Douketis JD. Deep vein thrombosis prophylaxis in hospitalized medical patients: current recommendations, general rates of implementation, and initiatives for improvement. Clin Chest Med 2010; 31 (04) 675-689
    CrossrefPubMedGoogle Scholar
  • 3 Wendelboe AM, Raskob GE. Global burden of thrombosis—epidemiologic aspects. Circ Res 2016; 118 (09) 1340-1347
    CrossrefPubMedGoogle Scholar
  • 4 ISTH Steering Committee for World Thrombosis Day. Thrombosis: a major contributor to the global disease burden. J Thromb Haemost 2014; 12 (10) 1580-1590
    CrossrefPubMedGoogle Scholar
  • 5 Palareti G, Schellong S. Isolated distal deep vein thrombosis: what we know and what we are doing. J Thromb Haemost 2012; 10 (01) 11-19
    CrossrefPubMedGoogle Scholar
  • 6 Robert-Ebadi H, Righini M. Management of distal deep vein thrombosis. Thromb Res 2017; 149: 48-55
    CrossrefPubMedGoogle Scholar
  • 7 Franco L, Giustozzi M, Agnelli G, Becattini C. Anticoagulation in patients with isolated distal deep vein thrombosis: a meta-analysis. J Thromb Haemost 2017; 15 (06) 1142-1154
    CrossrefPubMedGoogle Scholar
  • 8 Horner D, Hogg K, Body R, Nash MJ, Baglin T, Mackway-Jones K. The anticoagulation of calf thrombosis (ACT) project: results from the randomized controlled external pilot trial. Chest 2014; 146 (06) 1468-1477
    CrossrefPubMedGoogle Scholar
  • 9 Donadini MP, Dentali F, Pegoraro S. , et al. Long-term recurrence of venous thromboembolism after short-term treatment of symptomatic isolated distal deep vein thrombosis: a cohort study. Vasc Med 2017; 22 (06) 518-524
    CrossrefPubMedGoogle Scholar
  • 10 Kearon C. Natural history of venous thromboembolism. Circulation 2003; 107 (23) (Suppl. 01) I22-I30
    PubMedGoogle Scholar
  • 11 Righini M, Paris S, Le Gal G, Laroche JP, Perrier A, Bounameaux H. Clinical relevance of distal deep vein thrombosis. Review of literature data. Thromb Haemost 2006; 95 (01) 56-64
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Righini M, Galanaud J-P, Guenneguez H. , et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol 2016; 3 (12) e556-e562
    PubMedGoogle Scholar
  • 13 Kearon C, Akl EA, Comerota AJ. , et al. Antithrombotic therapy for VTE disease: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed.: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141 (2, Suppl): e419S-e496S
    CrossrefPubMedGoogle Scholar
  • 14 Kearon C, Akl EA, Ornelas J. , et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
    CrossrefPubMedGoogle Scholar
  • 15 Blann AD, Khoo CW. The prevention and treatment of venous thromboembolism with LMWHs and new anticoagulants. Vasc Health Risk Manag 2009; 5: 693-704
    PubMedGoogle Scholar
  • 16 Weitz JI, Haas S, Ageno W. , et al. Global Anticoagulant Registry in the Field - Venous Thromboembolism (GARFIELD-VTE). Rationale and design. Thromb Haemost 2016; 116 (06) 1172-1179
    Article in Thieme ConnectPubMedGoogle Scholar
  • 17 Schulman S, Kearon C. ; Subcommittee on Control of Anticoagulation of the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. Definition of major bleeding in clinical investigations of antihemostatic medicinal products in non-surgical patients. J Thromb Haemost 2005; 3 (04) 692-694
    CrossrefPubMedGoogle Scholar
  • 18 Kearon C, Ageno W, Cannegieter SC, Cosmi B, Geersing GJ, Kyrle PA. ; Subcommittees on Control of Anticoagulation, and Predictive and Diagnostic Variables in Thrombotic Disease. Categorization of patients as having provoked or unprovoked venous thromboembolism: guidance from the SSC of ISTH. J Thromb Haemost 2016; 14 (07) 1480-1483
    CrossrefPubMedGoogle Scholar
  • 19 Fine JP, Gray RJ. A proportional hazards model for the subdistribution of a competing risk. J Am Stat Assoc 1999; 94 (446) 496-509
    CrossrefPubMedGoogle Scholar
  • 20 Ageno W, Haas S, Weitz JI. , et al; GARFIELD-VTE investigators. Characteristics and management of patients with venous thromboembolism: the GARFIELD-VTE registry. Thromb Haemost 2019; 119 (02) 319-327
    Article in Thieme ConnectPubMedGoogle Scholar
  • 21 Galanaud JP, Sevestre-Pietri MA, Bosson JL. , et al; OPTIMEV-SFMV Investigators. Comparative study on risk factors and early outcome of symptomatic distal versus proximal deep vein thrombosis: results from the OPTIMEV study. Thromb Haemost 2009; 102 (03) 493-500
    Article in Thieme ConnectPubMedGoogle Scholar
  • 22 Galanaud JP, Quenet S, Rivron-Guillot K. , et al; RIETE INVESTIGATORS. Comparison of the clinical history of symptomatic isolated distal deep-vein thrombosis vs. proximal deep vein thrombosis in 11 086 patients. J Thromb Haemost 2009; 7 (12) 2028-2034
    CrossrefPubMedGoogle Scholar
  • 23 Utter GH, Dhillon TS, Salcedo ES. , et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg 2016; 151 (09) e161770
    CrossrefPubMedGoogle Scholar
  • 24 Galanaud JP, Sevestre MA, Genty C. , et al; OPTIMEV-SFMV investigators. Incidence and predictors of venous thromboembolism recurrence after a first isolated distal deep vein thrombosis. J Thromb Haemost 2014; 12 (04) 436-443
    CrossrefPubMedGoogle Scholar
  • 25 Barco S, Corti M, Trinchero A. , et al. Survival and recurrent venous thromboembolism in patients with first proximal or isolated distal deep vein thrombosis and no pulmonary embolism. J Thromb Haemost 2017; 15 (07) 1436-1442
    CrossrefPubMedGoogle Scholar
  • 26 Valerio L, Ambaglio C, Barone M. , et al. Recurrence risk after first symptomatic distal versus proximal deep vein thrombosis according to baseline risk factors. TH Open 2019; 3 (01) e58-e63
    Article in Thieme ConnectPubMedGoogle Scholar