Medicine by the Numbers

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Treatment of Distal DVT

 

Am Fam Physician. 2021 Apr 1;103(7):432-433.

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Study Population: Adults with distal deep venous thrombosis (DVT) diagnosed using venography or ultrasonography

Efficacy End Points: Incidence of recurrent venous thromboembolism (DVT or pulmonary embolism) and mortality

Harm End Points: Incidence of major bleeding and incidence of clinically relevant nonmajor bleeding

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TREATMENT OF DISTAL DVT

BenefitsHarms

Up to three months of anticoagulation* vs. observation or placebo

1 in 16 did not have recurrence of venous thromboembolism or DVT

1 in 23 had clinically relevant nonmajor bleeding


Three months or more vs. six weeks of anticoagulation*

1 in 12 did not have recurrence of venous thromboembolism 1 in 10 did not have recurrence of DVT

No clinically significant harms were noted


DVT = deep venous thrombosis.

*—Vitamin K antagonist.

TREATMENT OF DISTAL DVT

BenefitsHarms

Up to three months of anticoagulation* vs. observation or placebo

1 in 16 did not have recurrence of venous thromboembolism or DVT

1 in 23 had clinically relevant nonmajor bleeding


Three months or more vs. six weeks of anticoagulation*

1 in 12 did not have recurrence of venous thromboembolism 1 in 10 did not have recurrence of DVT

No clinically significant harms were noted


DVT = deep venous thrombosis.

*—Vitamin K antagonist.

Narrative: Distal (below the knee) DVT includes thrombosis of the tibial, peroneal, soleal, and gastrocnemius veins.1 Worldwide, the incidence of distal DVT in adults is estimated to be 0.1% per year, and distal DVT encompasses about one-third to one-half of all lower extremity DVTs.2,3 The standard treatments for distal DVT include anticoagulation or close observation with repeat evaluations to monitor for potential progression of the thrombosis, most significantly extension above the knee.3 Observation is a viable option because many distal DVTs will spontaneously resolve, although the exact percentage is unclear.4

The American College of Chest Physicians (CHEST) recommends anticoagulation if risk factors for DVT extension are present (weak recommendation with low-quality evidence).5 Risk factors include a positive d-dimer test result, extensive thrombosis (greater than 5 cm in length, involves multiple veins, greater than 7 mm in maximum diameter, close to proximal veins), no reversible provoking factor for DVT, active cancer, history of venous thromboembolism, or inpatient status. If no risk factors are present, CHEST recommends observation (weak recommendation with low-quality

Author disclosure: No relevant financial affiliations.


Copyright © 2021 MD Aware, LLC (theNNT.com). Used with permission.

This series is coordinated by Christopher W. Bunt, MD, AFP assistant medical editor, and Daniel Runde, MD, from the NNT Group.

A collection of Medicine by the Numbers published in AFP is available at https://www.aafp.org/afp/mbtn.

References

show all references

1. Shimabukuro N, Mo M, Hashiyama N, et al. Clinical course of asymptomatic isolated distal deep vein thrombosis of the leg: a single-institution study. Ann Vasc Dis. 2019;12(4):487–492....

2. Kesieme E, Kesieme C, Jebbin N, et al. Deep vein thrombosis: a clinical review. J Blood Med. 2011;2:59–69.

3. Robert-Ebadi H, Righini M. Should we diagnose and treat distal deep vein thrombosis? Hematology Am Soc Hematol Educ Program. 2017;(1):231–236.

4. Schellong SM. Distal DVT: worth diagnosing? Yes. J Thromb Haemost. 2007;5(suppl 1):51–54.

5. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report [published correction appears in Chest. 2016;150(4): 988]. Chest. 2016;149(2):315–352.

6. Kirkilesis G, Kakkos SK, Bicknell C, et al. Treatment of distal deep vein thrombosis. Cochrane Database Syst Rev. 2020;(4):CD013422.

 

 

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