Clinical question: What is the incidence of recurrence of venous thrombosis after a distal deep vein thrombosis (DVT)?
Background: Distal DVTs are frequently found but debate remains around whether treatment with anticoagulation is warranted and the optimal duration of anticoagulation when used.
Study design: Prospective cohort study
Setting: Østfold Hospital in Norway, a primary referral center
Synopsis: The study recruited 475 patients with distal DVT and treated them with anticoagulation for a median of 92 days. Patients were followed for a mean of 4.7 years and only seven patients were lost to follow up. The study found the recurrence rate of imaging-confirmed venous thrombosis to be 14.7% at five years and 27.2% at 10 years. This rate increased to 24.1% and 40.1% in those with unprovoked versus provoked initial distal DVTs. The rates of proximal DVT and pulmonary embolism (PE) were 10.1% and 16.3% overall at five and 10 years, respectively. In unprovoked cases, this increased to 19.5% and 27%, respectively. Major bleeding while on any anticoagulation was 1.5% overall and 0.8% in the direct-oral-anticoagulation group. Two bleedings were fatal, and both were in elderly patients over 85. One limitation is that cancer patients were excluded. While the study was a prospective review and all re-scans were ordered outside of the study, the clinical significance of recurrence events was not reviewed.
Bottom line: While U.S. guidelines on anticoagulation for distal DVTs remain mixed, for high-risk individuals or those with unprovoked distal DVTs, either monitoring or anticoagulation is worth consideration
Citation: Jørgensen CT, Tavoly M, et al. Incidence of bleeding and recurrence in isolated distal deep vein thrombosis: findings from the Venous Thrombosis Registry in Østfold Hospital. J Thromb Haemost. 2023;21(10):2824-32.
Dr. Knoll
Dr. Knoll is a hospitalist in the division of hospital medicine at NYU Langone Tisch Hospital and an assistant professor of medicine at the NYU Grossman School of Medicine, both in New York.