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
- Type de publi. : Article dans une revue
- Date de publi. : 01/08/2022
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Auteurs :
Behnood BikdeliCésar CaraballoJavier Trujillo-SantosJean-Philippe GalanaudPierpaolo Di MiccoVladimir RosaGemma Vidal CusidóSebastian SchellongMeritxell MelladoMaría del Valle MoralesOlga Gavín-SebastiánLucia MazzolaiHarlan KrumholzManuel MonrealPaolo PrandoniBenjamin BrennerDominique Farge-BancelRaquel BarbaLaurent BertolettiInna TzoranAbilio ReisMarijan BosevskiHenri BounameauxRadovan MalýPeter VerhammeJoseph CapriniMaría Dolores AdarragaPaloma Agudo de BlasJesús AibarCristina AmadoJuan Ignacio ArcelusAitor BallazCristina BarbagelataManuel BarrónBelén Barrón-AndrésÁngeles Blanco-MolinaFahd Beddar ChaibErnesto BotellaBeatriz Buño-RamiloJoaquín CastroLeyre ChascoJuan CriadoCristina de AncosJavier de MiguelJorge del ToroPablo Demelo-RodríguezAna María Díaz-BraseroMaría del Carmen Díaz-PedrocheJosé Antonio Díaz-PeromingoRaquel Díaz-SimónIrene Milagros DomínguezÁlvaro Dubois-SilvaJosé Carlos EscribanoFrancis EspósitoAna Isabel Farfán-SedanoCarmen Fernández-CapitánJosé Luis Fernández-ReyesÁngeles FidalgoCarme FontIria FranciscoCristina GabaraFrancisco Galeano-ValleMaría Angelina GarcíaFerrán García-BragadoMarta García de HerrerosRocío García de la GarzaCovadonga García-DíazAída Gil-DíazMario Giménez-SuauCovadonga Gómez-CuervoEnric GrauLeticia GuiradoJavier GutiérrezLuis Hernández-BlascoLuis Jara-PalomaresMaría Jesús JarasDavid JiménezRafael JiménezCarmen Jiménez-AlfaroInés JouMaría Dolores JoyaSara Lainez-JustoAntonio LaluezaAna Latorre-DíezJosé Luis LoboLuciano López-JiménezPatricia López-MiguelJuan José López-NúñezRaquel López-ReyesJuan Bosco López-SáezAlicia LorenzoOlga MadridanoAna MaestrePablo Javier MarchenaMar Martín del PozoFrancisco Martín-MartosDiego Martínez-UrbistondoCarmen MellaMaría Isabel MercadoArturo Muñoz-BlancoJosé Antonio NietoManuel Jesús Núñez-FernándezMónica Olid-VelillaSonia OtaloraRemedios OteroDiana Paredes-RuizPedro ParraVirginia ParraJosé María PedrajasMaría Luisa PerisJosé Antonio PorrasJosé PortilloPedro Ruiz-ArtachoNuria Ruiz-GiménezJusto Ruiz-RuizPablo Ruiz-SadaGiorgina SalgueiroRosario Sánchez-MartínezJuan Francisco Sánchez-Muñoz-TorreroTeresa SanchoSilvia SolerBeatriz Suárez-RodríguezJosé María SuriñachCarles TolosaMaría Isabel TorresAndrea Torres-SánchezFernando UresandiBeatriz ValeroReina ValleJosé Felipe VaronaCarmen Vázquez-FriolLaura VelaJerónimo Ramón VelaAurora VillalobosPaula VillaresCarles ZamoraCihan AyStephan NoppIngrid PabingerMatthias EngelenThomas VanasscheHugo Hyung Bok YooJana HirmerovaSandrine AccassatNassim Ait AbdallahAlessandra Bura-RiviereJudith Catella-ChatronFrancis CouturaudBenjamin CrichiPhilippe DebourdeauOlivier EspitiaNicolas FalvoClaire GrangeHélène HelferKarine LacutRaphael Le MaoIsabelle MahéPierre MorangeFarès MoustafaGéraldine PoenouGabrielle Sarlon-BartoliPierre SuchonIsabelle QuereReza NikandishAndrei BraesterGili KenetManuela BasagliaFranca BiloraCristiano BortoluzziBarbara BrandolinMaurizio CiammaichellaChiara CorgnaA. de AngelisEgidio ImbalzanoDaniela MastroiacovoSimona MerlaRaffaele PesaventoFluvio PomeroCarmine SiniscalchiAntonella TufanoAdriana VisonàNgoc Vo HongBeniamino ZalunardoDana KigitovicaElina RusaAndris SkrideSamuel FonsecaFilipa Martins-DuarteJose Meireles
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Organismes :
Brigham & Women’s Hospital [Boston]
Yale University [New Haven]
Cardiovascular Research Foundation [New York, NY, USA]
Yale University [New Haven]
Universidad Católica San Antonio de Murcia
University of Toronto
Centre Hospitalier Régional Universitaire [Montpellier]
Hospital Clínico Universitario Virgen de la Arrixaca = University Hospital Virgen de la Arrixaca [Murcia]
University Hospital Carl Gustav Carus [Dresden, Germany]
Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
IMIM-Hospital del Mar
Hospital Clínico Universitario “Lozano Blesa” [Zaragoza, Spain]
Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
Yale School of Medicine [New Haven, Connecticut]
Germans Trias i Pujol University Hospital [Badalona, Barcelona, Spain]
Universitat Autònoma de Barcelona = Autonomous University of Barcelona = Universidad Autónoma de Barcelona
Università degli Studi di Padova = University of Padua
Universidad Católica San Antonio de Murcia
Biologie Intégrative du Tissu Osseux
Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne]
- Publié dans JAMA Cardiology le 25/10/2020
Résumé : 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.
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