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CC BY 4.0 · TH Open 2021; 05(03): e239-e250
DOI: 10.1055/s-0041-1730038
Original Article

Management and Outcomes of Isolated Distal Deep Vein Thromboses: A Questionable Trend toward Long-Lasting Anticoagulation Treatment. Results from the START-Register

Gualtiero Palareti
1   Arianna Anticoagulazione Foundation, Bologna, Italy
,
Cristina Legnani
1   Arianna Anticoagulazione Foundation, Bologna, Italy
,
Emilia Antonucci
1   Arianna Anticoagulazione Foundation, Bologna, Italy
,
Sophie Testa
2   Centro Emostasi e Trombosi A O Istituti Ospitalieri di Cremona, Cremona, Italy
,
Daniela Mastroiacovo
3   Daniela Mastroiacovo MD, Dipartimento di Angiologia, Ospedale SS. Filippo e Nicola, Avezzano, (L'Aquila), Italy
,
Benilde Cosmi
4   Department of Angiology and Blood Coagulation, University Hospital, Bologna, Italy
,
Daniela Poli
5   SOD Malattie Aterotrombotiche, Azienda Ospedaliero Universitaria-Careggi, Firenze, Italy
,
Eugenio Bucherini
6   SS Aziendale di Angiologia Faenza AUSL Romagna, Ravenna, Italy
,
Francesco Dentali
7   Dipartimento di Medicina Interna, Ospedale di Circolo, Università dell'Insubria, Varese, Italy
,
Andrea Fontanella
8   Dir. Dipartimento di Medicina, Ospedale del Buon Consiglio-Fatebenefratelli, Napoli, Italy
,
Nicola Mumoli 
9   Department of Internal Medicine, Magenta Hospital, Magenta (MI), Italy
,
Davide Imberti
10   UO Medicina Interna ERI, Ospedale Civile, Piacenza, Italy
,
Anna Falanga 
11   Università Milano Bicocca, Dipartimento di Medicina e Chirurgia, Italy
,
Walter Ageno
12   UOC Immunoematologia e Medicina Trasfusionale ASST Bergamo, Italy
,
Fulvio Pomero
13   Dipartimento di Emergenza e Accettazione, Centro Trombosi ed Emostasi, Ospedale di Circolo, Università dell'Insubria, Varese, Italy
› Author Affiliations Funding The Arianna Anticoagulation Foundation promotes and supports the START-Register, including the present study. The authors do not disclose receipt of the financial support for the research, authorship, and/or publication of this article.
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Abstract

Background Isolated distal deep vein thromboses (IDDVT) are frequently diagnosed; however, their natural history and real risk of complications are still uncertain. Though treatment is still not well standardized, international guidelines recommend no more than 3 months of anticoagulation therapy. We investigated how Italian clinicians treat IDDVT patients in their real life in our country.

Methods Baseline characteristics and clinical history of the patients enrolled in the prospective, observational, multicenter START-Register for a first IDDVT or proximal DVT (PDVT) were analyzed.

Results Overall, 412 IDDVT patients were significantly younger, with better renal function, and more frequent major transient risk factors, when compared with 1,173 PDVT patients. The anticoagulation duration was >180 days in 52.7% of IDDVT patients (70.7% in PDVT). During treatment, bleeding occurred in 5.6 and 2.8% patient-years in IDDVT and PDVT, respectively (p = 0082). Bleeding was more frequent in IDDVT than PDVT patients treated with warfarin (6.8 vs. 3.2 patient-years, p = 0.0228, respectively). Thrombotic complications occurred in 1.1 and 2.4% patient-years in IDDVT and PDVT patients, respectively. Analyzing together the two groups, 66.1% of bleeds and 86.1% thrombotic complications occurred after 90 days anticoagulation treatment.

Conclusion The large majority of IDDVT patients received anticoagulation for more than 3 months. Most bleeding and thrombotic complications occurred after the first 90 days of anticoagulation therapy. These results indicate that an extended anticoagulation beyond 90 days in IDDVT patients is associated with increased risk of complications. Whether an extended treatment may lower recurrences after anticoagulation withdrawal should be assessed by specifically designed studies.

Keywords

isolated distal deep vein thrombosis - oral anticoagulant - bleeding - duration of treatment


Publication History

Received: 05 February 2021

Accepted: 12 April 2021

Article published online:
08 July 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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