PDF herunterladen
Semin Thromb Hemost 2017; 43(08): 836-848
DOI: 10.1055/s-0037-1604085
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

A Systematic Review and Meta-analysis Comparing Anticoagulation versus No Anticoagulation and Shorter versus Longer duration of Anticoagulation for Treatment of Isolated Distal Deep Vein Thrombosis

Ming Sheng Lim
1   Department of Haematology, Calvary Mater Hospital, Waratah, New South Wales, Australia
,
Anita Ariyarajah
2   Hunter Cancer Research Alliance, Newcastle, Australia
,
Christopher Oldmeadow
2   Hunter Cancer Research Alliance, Newcastle, Australia
3   Hunter Medical Research Institute, Newcastle, Australia
4   University of Newcastle, Callaghan, New South Wales, Australia
,
Alix Hall
2   Hunter Cancer Research Alliance, Newcastle, Australia
3   Hunter Medical Research Institute, Newcastle, Australia
4   University of Newcastle, Callaghan, New South Wales, Australia
,
Anoop K. Enjeti
1   Department of Haematology, Calvary Mater Hospital, Waratah, New South Wales, Australia
2   Hunter Cancer Research Alliance, Newcastle, Australia
3   Hunter Medical Research Institute, Newcastle, Australia
4   University of Newcastle, Callaghan, New South Wales, Australia
5   Pathology North Hunter, NSW Health Pathology, Newcastle New South Wales, Australia
› Institutsangaben
Weitere Informationen

Publikationsverlauf

Publikationsdatum:
06. September 2017 (online)

    Lizenzen und Reprints

Abstract

Isolated distal deep vein thrombosis (DVT) represents an important clinical problem but there is no consensus regarding its management. The aim of this review was to evaluate the safety, efficacy, and shorter versus longer duration of anticoagulation in patients with isolated distal DVT. A systematic search was conducted using MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systemic Reviews. Studies reporting rates of symptomatic pulmonary embolism (PE), recurrent DVT, proximal extension, and/or major bleeding were included. Fourteen studies (six randomized controlled trials, eight cohorts) involving 2,918 patients met the eligibility criteria (with a total of 13 meeting criteria for the meta-analysis). Compared with no anticoagulation, anticoagulation was associated with a significant reduction in proximal extension (odds ratio [OR]: 0.29; 95% confidence interval [CI]: 0.13–0.67; p < 0.004), recurrent DVT (OR: 0.16; 95% CI: 0.04–0.65; p = 0.01), and the composite end-point of proximal extension/PE (OR: 0.34; 95% CI: 0.16–0.72; p = 0.005); however, no significant differences in PE (OR: 0.47; 95% CI: 0.17–1.34; p = 0.16) or major bleeding (OR: 1.49; 95% CI: 0.33–6.86; p = 0.60) were observed. Anticoagulation for a longer duration (≥8 vs. ≤6 weeks) was associated with a significant reduction in proximal extension (OR: 0.23; 95% CI: 0.11–0.48; p < 0.001) but not for other outcomes.

Keywords

isolated - distal - calf - deep vein thrombosis - anticoagulation

Funding

We acknowledge the assistance of Pathology North PPTF funds toward costs of the systematic analysis.


Supplementary Material

 

  • References

  • 1 Righini M, Bounameaux H. Clinical relevance of distal deep vein thrombosis. Curr Opin Pulm Med 2008; 14 (05) 408-413
    CrossrefPubMedGoogle Scholar
  • 2 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
  • 3 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 11086 patients. J Thromb Haemost 2009; 7 (12) 2028-2034
    CrossrefPubMedGoogle Scholar
  • 4 Merriman E, Chunilal S, McRae S, Brighton T, Tran H. Two weeks of low molecular weight heparin for isolated symptomatic distal vein thrombosis (twister study): interim analysis of first 100 patients – post thrombotic syndrome sub-study. J Thromb Haemost 2015; 13 (Suppl. 02) 1-997 . Abstract PO468
    PubMedGoogle Scholar
  • 5 Robert-Ebadi H, Righini M. Management of distal deep vein thrombosis. Thromb Res 2017; 149: 48-55
    CrossrefPubMedGoogle Scholar
  • 6 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
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 7 Palareti G. How I treat isolated distal deep vein thrombosis (IDDVT). Blood 2014; 123 (12) 1802-1809
    CrossrefPubMedGoogle Scholar
  • 8 Palareti G, Sartori M. Treatment of isolated below the knee deep vein thrombosis. Curr Atheroscler Rep 2016; 18 (07) 37
    CrossrefPubMedGoogle Scholar
  • 9 Horner D, Hogg K, Body R. Should we be looking for and treating isolated calf vein thrombosis?. Emerg Med J 2016; 33 (06) 431-437
    CrossrefPubMedGoogle Scholar
  • 10 Porfidia A, Carnicelli A, Bonadia N, Pola R, Landolfi R. Controversies in venous thromboembolism: the unique case of isolated distal deep vein thrombosis. Intern Emerg Med 2016; 11 (06) 775-779
    CrossrefPubMedGoogle Scholar
  • 11 Masuda EM, Kistner RL, Musikasinthorn C, Liquido F, Geling O, He Q. The controversy of managing calf vein thrombosis. J Vasc Surg 2012; 55 (02) 550-561
    CrossrefPubMedGoogle Scholar
  • 12 De Martino RR, Wallaert JB, Rossi AP, Zbehlik AJ, Suckow B, Walsh DB. A meta-analysis of anticoagulation for calf deep venous thrombosis. J Vasc Surg 2012; 56 (01) 228-37.e1 ; discussion 236–237
    CrossrefPubMedGoogle Scholar
  • 13 Garry J, Duke A, Labropoulos N. Systematic review of the complications following isolated calf deep vein thrombosis. Br J Surg 2016; 103 (07) 789-796
    CrossrefPubMedGoogle Scholar
  • 14 Schulman S, Angerås U, Bergqvist D, Eriksson B, Lassen MR, Fisher W. ; 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 surgical patients. J Thromb Haemost 2010; 8 (01) 202-204
    CrossrefPubMedGoogle Scholar
  • 15 Schwarz T, Buschmann L, Beyer J, Halbritter K, Rastan A, Schellong S. Therapy of isolated calf muscle vein thrombosis: a randomized, controlled study. J Vasc Surg 2010; 52 (05) 1246-1250
    CrossrefPubMedGoogle Scholar
  • 16 Macdonald PS, Kahn SR, Miller N, Obrand D. Short-term natural history of isolated gastrocnemius and soleal vein thrombosis. J Vasc Surg 2003; 37 (03) 523-527
    CrossrefPubMedGoogle Scholar
  • 17 Sales CM, Haq F, Bustami R, Sun F. Management of isolated soleal and gastrocnemius vein thrombosis. J Vasc Surg 2010; 52 (05) 1251-1254
    CrossrefPubMedGoogle Scholar
  • 18 Higgins JP, Altman DG, Gøtzsche PC. , et al; Cochrane Bias Methods Group; Cochrane Statistical Methods Group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ 2011; 343 (18) d5928
    CrossrefPubMedGoogle Scholar
  • 19 Liberati A, Altman DG, Tetzlaff J. , et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and elaboration. BMJ 2009; 339: b2700
    CrossrefPubMedGoogle Scholar
  • 20 Righini M, Galanaud JP, 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
    CrossrefPubMedGoogle Scholar
  • 21 Lagerstedt CI, Olsson CG, Fagher BO, Oqvist BW, Albrechtsson U. Need for long-term anticoagulant treatment in symptomatic calf-vein thrombosis. Lancet 1985; 2 (8454): 515-518
    PubMedGoogle Scholar
  • 22 Schulman S, Rhedin AS, Lindmarker P. , et al; Duration of Anticoagulation Trial Study Group. A comparison of six weeks with six months of oral anticoagulant therapy after a first episode of venous thromboembolism. N Engl J Med 1995; 332 (25) 1661-1665
    CrossrefPubMedGoogle Scholar
  • 23 Pinede L, Ninet J, Duhaut P. , et al; Investigators of the “Durée Optimale du Traitement AntiVitamines K” (DOTAVK) Study. Comparison of 3 and 6 months of oral anticoagulant therapy after a first episode of proximal deep vein thrombosis or pulmonary embolism and comparison of 6 and 12 weeks of therapy after isolated calf deep vein thrombosis. Circulation 2001; 103 (20) 2453-2460
    CrossrefPubMedGoogle Scholar
  • 24 Ferrara F, Meli F, Amato C. , et al. Optimal duration of treatment in surgical patients with calf venous thrombosis involving one or more veins. Angiology 2006; 57 (04) 418-423
    CrossrefPubMedGoogle Scholar
  • 25 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
  • 26 Labropoulos N, Kang SS, Mansour MA, Giannoukas AD, Moutzouros V, Baker WH. Early thrombus remodelling of isolated calf deep vein thrombosis. Eur J Vasc Endovasc Surg 2002; 23 (04) 344-348
    CrossrefPubMedGoogle Scholar
  • 27 Astermark J, Björgell O, Lindén E, Lethagen S, Nilsson P, Berntorp E. Low recurrence rate after deep calf-vein thrombosis with 6 weeks of oral anticoagulation. J Intern Med 1998; 244 (01) 79-82
    PubMedGoogle Scholar
  • 28 Parisi R, Visonà A, Camporese G. , et al. Isolated distal deep vein thrombosis: efficacy and safety of a protocol of treatment. Treatment of isolated calf thrombosis (TICT) study. Int Angiol 2009; 28 (01) 68-72
    PubMedGoogle Scholar
  • 29 Sartori M, Migliaccio L, Favaretto E, Palareti G, Cosmi B. Two years outcome of isolated distal deep vein thrombosis. Thromb Res 2014; 134 (01) 36-40
    CrossrefPubMedGoogle Scholar
  • 30 Sule AA, Chin TJ, Handa P, Earnest A. Should symptomatic, isolated distal deep vein thrombosis be treated with anticoagulation?. Int J Angiol 2009; 18 (02) 83-87
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 31 Li AY, Woulfe T, Rolfe-Vyson V, Rowland V, Simpson D, Merriman E. Management and outcomes of axial isolated distal deep vein thrombosis at North Shore Hospital, New Zealand: a retrospective audit. Intern Med J 2015; 45 (02) 177-182
    CrossrefPubMedGoogle Scholar
  • 32 Brateanu A, Patel K, Chagin K. , et al. Probability of developing proximal deep-vein thrombosis and/or pulmonary embolism after distal deep-vein thrombosis. Thromb Haemost 2016; 115 (03) 608-614
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 33 Utter GH, Dhillon TS, Salcedo ES. , et al. Therapeutic anticoagulation for isolated calf deep vein thrombosis. JAMA Surg 2016; 151 (09) e161770
    CrossrefPubMedGoogle Scholar
  • 34 Palareti G, Cosmi B, Lessiani G. , et al. Evolution of untreated calf deep-vein thrombosis in high risk symptomatic outpatients: the blind, prospective CALTHRO study. Thromb Haemost 2010; 104 (05) 1063-1070
    Artikel in Thieme ConnectPubMedGoogle Scholar
  • 35 Boutitie F, Pinede L, Schulman S. , et al. Influence of preceding length of anticoagulant treatment and initial presentation of venous thromboembolism on risk of recurrence after stopping treatment: analysis of individual participants' data from seven trials. BMJ 2011; 342: d3036
    CrossrefPubMedGoogle Scholar
  • 36 Kearon C, Akl EA, Comerota AJ. , et al; American College of Chest Physicians. 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-e494S
    CrossrefPubMedGoogle Scholar
  • 37 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