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Proximal DVT associated with worse outcomes than isolated distal deep vein thrombosis: JAMA
![Proximal DVT associated with worse outcomes than isolated distal deep vein thrombosis: JAMA Proximal DVT associated with worse outcomes than isolated distal deep vein thrombosis: JAMA](https://medicaldialogues.in/h-upload/2022/07/19/750x450_181245-untitled-design-57.webp)
USA: Isolated distal deep vein thrombosis (IDDVT) causes lower all-cause mortality and fewer venous thromboembolism (VTE) deterioration events compared to proximal deep vein thrombosis (DVT), states an article published in the JAMA Cardiology.
Deep vein thrombosis, a blood clot in a deep vein, usually in the legs is the third most common vascular disease. Most DVTs resolve on their own, but if the clot breaks loose and travels to the lung [pulmonary embolism (PE)], the prognosis can be more severe. Proximal DVT is thrombosis located in the popliteal, femoral, or iliac veins. Isolated distal DVT (IDDVT) is thrombosis in infrapopliteal veins without proximal extension or PE and accounts for one-fourth to one-half of all diagnosed leg DVTs. Insufficient data exist about the clinical presentation, and short-term, and long-term outcomes of patients with IDDVT.
Bikdeli B, Harvard Medical School, Massachusetts, and the research team conducted a study to determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare them with patients with proximal DVT
Researchers analyzed data of 33,897 patients with IDDVT and 5,938 patients with proximal DVT using data from the RIETE registry. Patients with a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection were excluded from the study. Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as the subsequent development of proximal DVT or PE.
Key findings of the analysis,
• Compared to patients with proximal DVT, those with IDDVT had a lower comorbidity burden but were more likely to have had recent surgery or to have received hormonal therapy
• Patients with IDDVT had a lower risk of 90-day mortality compared to those with proximal DVT (OR- 0.47). Findings were similar in 1-year unadjusted analyses (HR-0.52) and adjusted analyses (HR-0.72)
• Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR-0.83).
• Additionally, in 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with a lower risk of VTE deterioration (adjusted HR-0.48)
• By 1-year follow-up, symptoms or signs of the post-thrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%).
The authors conclude that patients with IDDVT had a less dire prognosis compared to those with proximal DVT. These differences were likely multifactorial, including demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and post-thrombotic syndrome. Mortality related to pulmonary embolism (PE) was low in short- and long-term follow-up of patients with IDDVT.
Future RCTs are needed to assess the optimal long-term management of IDDVT, the authors wrote.
Reference:
Bikdeli B, Caraballo C, Trujillo-Santos J, et al. Clinical Presentation and Short- and Long-term Outcomes in Patients With Isolated Distal Deep Vein Thrombosis vs Proximal Deep Vein Thrombosis in the RIETE Registry. JAMA Cardiol. Published online July 13, 2022. doi:10.1001/jamacardio.2022.1988
BDS
Dr. Hiral patel (BDS) has completed BDS from Gujarat University, Baroda. She has worked in private dental steup for 8years and is currently a consulting general dentist in mumbai. She has recently completed her advanced PG diploma in clinical research and pharmacovigilance. She is passionate about writing and loves to read, analyses and write informative medical content for readers. She can be contacted at editorial@medicaldialogues.in.
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: editorial@medicaldialogues.in. Contact no. 011-43720751