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
Behnood Bikdeli, César Caraballo, Javier Trujillo‐Santos, J.‐P. Galanaud, Pierpaolo Di Micco, V. Rosa, Gemma Vidal Cusidó, Sebastian Schellong, Meritxell Mellado, María del Valle Morales, Olga Gavín‐Sebastián, Lucia Mazzolai, Harlan M. Krumholz, Manuel Monréal, RIETE Investigators, Paolo Prandoni, Benjamin Brenner, Dominique Farge, Raquel Barba, Laurent Bertoletti, Inna Tzoran, Abílio Reis, Marijan Bosevski, Henri Bounameaux, Radován Malý, Peter Verhamme, Joseph A. Caprini, María Dolores Adarraga, Paloma Agudo de Blas, Jesús Aibar, Cristina Amado, Juan I. Arcelus, Aitor Ballaz, Cristina Barbagelata, Manuel Barrón, B. Barrón‐Andrés, Ángeles Blanco‐Molina, Fahd Beddar Chaib, Ernesto Botella, Beatriz Buño-Ramilo, Joaquín Castro, Leyre Chasco, Juan Criado, Cristina de Ancos, Javier de Miguel‐Díez, J. del Toro, Pablo Demelo‐Rodríguez, Ana María Díaz-Brasero, María del Carmen Díaz-Pedroche, José Antonio Díaz‐Peromingo, Raquel Díaz‐Simón, Irene Milagros Domínguez, Álvaro Dubois-Silva, José Carlos Escribano, F. Espósito, Ana Isabel Farfán‐Sedano, Carmen Fernández‐Capitán, José Luis Fernández‐Reyes, Ángeles Fidalgo, Carme Font, Iria Francisco, Cristina Gabara, Francisco Galeano‐Valle, Maria A. García, F. García‐Bragado, Marta García de Herreros, Rocío García de la Garza, Covadonga García-Díaz, Aída Gil‐Díaz, M. Giménez-Suau, Covadonga Gómez‐Cuervo, Enric Grau, Leticia Guirado, Javier Cuesta, Luis Blasco, Luis Jara‐Palomares, M.J. Jaras, David Jiménez, Rafael Jiménez, Carmen Jiménez-Alfaro, I. Jou, M.D. Joya, S. Láinez-Justo, Antonio Lalueza, Ana Latorre-Díez, José Luís Lobo, Luciano López‐Jiménez, Patricia López-Miguel, Juan J. López-Núñez, Raquel López-Reyes, J.B. López‐Sáez, Alicia Lorenzo, Olga Madridano, Ana Maestre, Pablo Javier Marchena, M. Martín del Pozo, F. Martín‐Martos, Diego Martínez‐Urbistondo, C Mella, María Isabel Mercado
Abstract
Importance: Insufficient data exist about the clinical presentation, short-term, and long-term outcomes of patients with isolated distal deep vein thrombosis (IDDVT), that is, thrombosis in infrapopliteal veins without proximal extension or pulmonary embolism (PE). Objective: To determine the clinical characteristics, short-term, and 1-year outcomes in patients with IDDVT and to compare the outcomes in unadjusted and multivariable adjusted analyses with patients who had proximal DVT. Design, Setting, and Participants: This was a multicenter, international cohort study in participating sites of the Registro Informatizado Enfermedad Tromboembólica (RIETE) registry conducted from March 1, 2001, through February 28, 2021. Patients included in this study had IDDVT. Patients with proximal DVT were identified for comparison. Patients were excluded if they had a history of asymptomatic DVT, upper-extremity DVT, coexisting PE, or COVID-19 infection. Main Outcomes and Measures: Primary outcomes were 90-day and 1-year mortality, 1-year major bleeding, and 1-year venous thromboembolism (VTE) deterioration, which was defined as subsequent development of proximal DVT or PE. Results: A total of 33 897 patients were identified with isolated DVT (without concomitant PE); 5938 (17.5%) had IDDVT (mean [SD] age, 61 [17] years; 2975 male patients [50.1%]), and 27 959 (82.5%) had proximal DVT (mean [SD] age, 65 [18] years; 14 315 male patients [51.2%]). Compared with individuals 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 lower risk of 90-day mortality compared with those with proximal DVT (odds ratio [OR], 0.47; 95% CI, 0.40-0.55). Findings were similar in 1-year unadjusted analyses (hazard ratio [HR], 0.52; 95% CI, 0.46-0.59) and adjusted analyses (HR, 0.72; 95% CI, 0.64-0.82). Patients with IDDVT had a lower 1-year hazard of VTE deterioration (HR, 0.83; 95% CI, 0.69-0.99). In 1-year adjusted analyses of patients without an adverse event within the first 3 months, IDDVT was associated with lower risk of VTE deterioration (adjusted HR, 0.48; 95% CI, 0.24-0.97). By 1-year follow-up, symptoms or signs of postthrombotic syndrome were less common in patients with IDDVT (47.6% vs 60.5%). Conclusions and Relevance: Results of this cohort study suggest that patients with IDDVT had a less ominous prognosis compared with patients with proximal DVT. Such differences were likely multifactorial, including the differences in demographics, risk factors, comorbidities, particularly for all-cause mortality, and a potential association of thrombus location with VTE deterioration and postthrombotic syndrome. Randomized clinical trials are needed to assess the optimal long-term management of IDDVT.