Department of Medicine and Ageing Sciences, “G. d’Annunzio” University, Chieti, Italy
Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Pol Arch Intern Med. 2023 Aug 30;133(7-8). doi: 10.20452/pamw.16543. Epub 2023 Aug 7.
Isolated distal deep vein thrombosis (IDDVT) is a frequent manifestation of venous thromboembolism (VTE), accounting for up to 50% cases of lower‑extremity deep vein thrombosis (DVT). As compared with proximal DVT, IDDVT is more frequently associated with transient risk factors and less often occurs unprovoked or in the presence of permanent risk factors. IDDVT generally carries a significantly lower risk of proximal extension, post‑thrombotic syndrome, and recurrence than proximal DVT. Nevertheless, some patient subgroups, such as those with active cancer, other predisposing permanent risk factors, prior VTE, unprovoked IDDVT, persistently restricted mobility, and trifurcation or bilateral involvement, exhibit a non‑negligible recurrence risk. Unlike in proximal DVT, the optimal therapeutic management of IDDVT remains uncertain. In clinical practice, the vast majority of IDDVT patients are managed with anticoagulation rather than with surveillance serial compression ultrasonography, which tends to be reserved to individuals at a high bleeding risk. Available data seem to favor anticoagulant therapy over no anticoagulation, thanks to a significant reduction in the risk for proximal extension and recurrence, without increased bleeding risk. Recent results of the RIDTS (Rivaroxaban for the Treatment of Symptomatic Isolated Distal Deep Vein Thrombosis) randomized clinical trial with rivaroxaban further support the use of anticoagulant therapy for 3 months over shorter durations (eg, ≤6 weeks). In this review, we offer an updated overview of the epidemiology, risk factors, and clinical course of IDDVT, with a focus on the therapeutic management in light of current guideline recommendations and most recent evidence. We also present real‑life clinical cases of IDDVT with proposed therapeutic approaches, and highlight major challenges and gaps in this field.
孤立性远端深静脉血栓形成（IDDVT）是静脉血栓栓塞症（VTE）的常见表现，占下肢深静脉血栓形成（DVT）的比例高达 50%。与近端 DVT 相比，IDDVT 更常与短暂性危险因素相关，较少发生无诱因或存在永久性危险因素的情况。IDDVT 一般发生近端延伸、血栓后综合征和复发的风险明显低于近端 DVT。然而，一些患者亚组，如活动性癌症患者、其他易患永久性危险因素的患者、既往 VTE 患者、无诱因 IDDVT 患者、持续受限的活动能力患者和三叉或双侧受累患者，具有不可忽视的复发风险。与近端 DVT 不同，IDDVT 的最佳治疗管理仍不确定。在临床实践中，绝大多数 IDDVT 患者接受抗凝治疗，而不是连续监测压迫超声检查，后者往往保留给出血风险高的个体。由于近端延伸和复发风险显著降低，而出血风险无增加，现有数据似乎支持抗凝治疗优于无抗凝治疗。最近的 rivaroxaban 治疗有症状孤立性远端深静脉血栓形成（RIDTS）随机临床试验的结果进一步支持抗凝治疗 3 个月优于较短时间（如≤6 周）。在这篇综述中，我们根据当前指南建议和最新证据，提供了关于 IDDVT 的流行病学、危险因素和临床病程的最新概述，重点介绍了治疗管理。我们还介绍了 IDDVT 的真实临床病例和提出的治疗方法，并强调了该领域的主要挑战和差距。
