Journal of thrombosis and haemostasis : JTH · 2026
Outcomes and predictors of complications after distal deep vein thrombosis: a prospective analysis of 8488 patients.
СтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
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Catella Judith, Galanaud Jean Philippe, Fernandez Martínez de Septién Carmen, Demelo-Rodríguez Pablo, Guirado Leticia, Valle Reina, Pedrajas José María, Zalunardo Beniamino, Brenner Benjamin, Monreal Manuel, Registro Informatizado de la Enfermedad TromboEmbolica
Аннотация
BACKGROUND: The natural history and optimal management of isolated distal deep vein thrombosis (iDDVT) remain uncertain.
OBJECTIVES: We assessed the incidence, timing, severity, and predictors of symptomatic pulmonary embolism (PE), recurrent deep vein thrombosis (DVT), major bleeding, and mortality in a large real-world cohort of patients with iDDVT.
METHODS: We analyzed 8488 patients with iDDVT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry. Outcomes were evaluated separately during anticoagulation and after its discontinuation using competing-risk models. Multivariable cause-specific Cox regression analyses identified independent predictors for each treatment phase.
RESULTS: Over a median follow-up of 190 days, 116 patients (1.4%) developed symptomatic PE, 363 (4.3%) had recurrent DVT, and 137 (1.6%) experienced major bleeding. Thrombotic events occurred more frequently after stopping anticoagulation, while most bleeding episodes occurred during treatment. Major bleeding had the highest 10-day mortality (15%), exceeding that of PE (6%). During anticoagulation, active cancer predicted all 3 complications; male sex predicted PE; and renal impairment, anemia, chronic lung disease, recent bleeding, and psychotropic drug use predicted major bleeding. After discontinuation, psychotropic drug use predicted PE; corticosteroid use predicted recurrent DVT and major bleeding; and renal impairment and cancer remained strong predictors of major bleeding. Transient risk factors were consistently associated with a lower risk of recurrence.
CONCLUSION: iDDVT is not a benign condition. Although recurrent DVT was the most frequent complication, PE and especially major bleeding accounted for substantial early mortality. Distinct phase-specific risk profiles may help guide personalized decisions regarding anticoagulation intensity, duration, and posttreatment monitoring.
OBJECTIVES: We assessed the incidence, timing, severity, and predictors of symptomatic pulmonary embolism (PE), recurrent deep vein thrombosis (DVT), major bleeding, and mortality in a large real-world cohort of patients with iDDVT.
METHODS: We analyzed 8488 patients with iDDVT from the Registro Informatizado de la Enfermedad TromboEmbólica Registry. Outcomes were evaluated separately during anticoagulation and after its discontinuation using competing-risk models. Multivariable cause-specific Cox regression analyses identified independent predictors for each treatment phase.
RESULTS: Over a median follow-up of 190 days, 116 patients (1.4%) developed symptomatic PE, 363 (4.3%) had recurrent DVT, and 137 (1.6%) experienced major bleeding. Thrombotic events occurred more frequently after stopping anticoagulation, while most bleeding episodes occurred during treatment. Major bleeding had the highest 10-day mortality (15%), exceeding that of PE (6%). During anticoagulation, active cancer predicted all 3 complications; male sex predicted PE; and renal impairment, anemia, chronic lung disease, recent bleeding, and psychotropic drug use predicted major bleeding. After discontinuation, psychotropic drug use predicted PE; corticosteroid use predicted recurrent DVT and major bleeding; and renal impairment and cancer remained strong predictors of major bleeding. Transient risk factors were consistently associated with a lower risk of recurrence.
CONCLUSION: iDDVT is not a benign condition. Although recurrent DVT was the most frequent complication, PE and especially major bleeding accounted for substantial early mortality. Distinct phase-specific risk profiles may help guide personalized decisions regarding anticoagulation intensity, duration, and posttreatment monitoring.