Clinical Presentation and Outcomes of Patients With Cancer-Associated Isolated Distal Deep Vein Thrombosis
J.‐P. Galanaud, Javier Trujillo‐Santos, Behnood Bikdeli, Laurent Bertoletti, Pierpaolo Di Micco, Géraldine Poénou, C. Falgá, Marija Zdraveska, Jorge Roberto Perrout de Lima, F. Rivera-Cívico, Josefa Fernández Muixi, Manuel Monréal, on behalf of the RIETE Investigators, María Dolores Adarraga, A. Alberich-Conesa, Paloma Agudo, Jesús Aibar, Joaquín Alfonso, Cristina Amado, Soraia Amorós, M. Angelina-García, Juan I. Arcelus, Aitor Ballaz, Raquel Barba, Cristina Barbagelata, Manuel Barrón, B. Barrón‐Andrés, José Bascuñana, Fahd Beddar-Chaib, Ángeles Blanco‐Molina, Ernesto Botella, Leyre Chasco, Pau Cerdà, Juan Criado, J. del Toro, Cristina de Ancos, Pablo Demelo‐Rodríguez, C. De Juana-Izquierdo, Ana María Díaz-Brasero, María del Carmen Díaz-Pedroche, José Antonio Díaz‐Peromingo, Álvaro Dubois-Silva, José Carlos Escribano, F. Espósito, C. Falgá, Ana Isabel Farfán‐Sedano, C. Fernández‐Aracil, Carmen Fernández‐Capitán, B. Fernández-Jiménez, J. Fernández-Muixí, José Luis Fernández‐Reyes, Carme Font, Iria Francisco, Cristina Gabara, Marta García de Herreros, F. García‐Bragado, Alberto García‐Ortega, Olga Gavín‐Sebastián, María Gil-De Gómez, Aída Gil‐Díaz, Covadonga Gómez‐Cuervo, J. González‐Martínez, Enric Grau, Leticia Guirado, Javier Gutiérrez, Luis Blasco, M.J. Jaras, David Jiménez, I. Jou, M.D. Joya, Marta Olimpia Lago-Rodríguez, S. Láinez-Justo, Ana Latorre-Díez, Ramón Lecumberri, José Manuel León-Ramírez, Jorge Roberto Perrout de Lima, José Luís Lobo, M. López-De la Fuente, Luciano López-Jiménez, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, Antonio López‐Ruiz, J.B. López‐Sáez, M.A. Lorente, Alicia Lorenzo, M. Lumbierres, Olga Madridano, Ana Maestre, Laia Mas-Maresma, María Ángeles Marcos, Javier Miguel Martín Guerra, F. Martín‐Martos, Iván Martínez-Redondo, Meritxell Mellado, Elisabeth Mena, María Isabel Mercado, Jorge Moisés, Manuel Monréal, Arturo Muñoz Blanco
Abstract
PURPOSE: Patients with isolated distal deep vein thrombosis (DVT) have lower rates of adverse outcomes (death, venous thromboembolism [VTE] recurrence or major bleeding) than those with proximal DVT. It is uncertain if such findings are also observed in patients with cancer. METHODS: Using data from the international Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, we compared the risks of adverse outcomes at 90 days (adjusted odds ratio [aOR]; 95% CI) and 1 year (adjusted hazard ratio [aHR; 95% CI]) in 886 patients with cancer-associated distal DVT versus 5,196 patients with cancer-associated proximal DVT and 5,974 patients with non-cancer-associated distal DVT. RESULTS: More than 90% of patients in each group were treated with anticoagulants for at least 90 days. At 90 days, the adjusted risks of death, VTE recurrence, or major bleeding were lower in patients with non-cancer-associated distal DVT than in patients with cancer-associated distal DVT (reference): aOR = 0.16 (0.11-0.22), aOR = 0.34 (0.22-0.54), and aOR = 0.47 (0.27-0.80), respectively. The results were similar at 1-year follow-up: aHR = 0.12 (0.09-0.15), aHR = 0.39 (0.28-0.55), and aHR = 0.51 (0.32-0.82), respectively. Risks of death, VTE recurrence, and major bleeding were not statistically different between patients with cancer-associated proximal versus distal DVT, both at 90 days: aOR = 1.11 (0.91-1.36), aOR = 1.10 (0.76-1.62), and aOR = 1.18 (0.76-1.83), respectively, and 1 year: aHR = 1.01 (0.89-1.15), aHR = 1.02 (0.76-1.35), and aHR = 1.10 (0.76-1.61), respectively. However, more patients with cancer-associated proximal DVT, compared with cancer-associated distal DVT, developed fatal pulmonary embolism (PE) during follow-up: The risk difference was 0.40% (95% CI, 0.23 to 0.58). CONCLUSION: Cancer-associated distal DVT has serious and relatively comparable outcomes compared with cancer-associated proximal DVT. The lower risk of fatal PE from cancer-associated distal DVT needs further investigation.