Use of Direct Oral Anticoagulation for Isolated Distal Deep Vein Thrombosis in Japanese Orthopedic Patients.

Although direct oral anticoagulants (DOAC) have become widely used, little is known about the efficacy of DOAC for isolated distal deep vein thrombosis (DVT). In-hospitalized orthopedic patients with isolated distal DVT who were diagnosed from 2016 to 2018 were enrolled and were followed for 1 year. Embolic events included symptomatic pulmonary embolism (PE) and DVT extension above the knee. Bleeding events were determined in the presence of bleeding academic research consortium (BARC) 2, 3 or 5 bleeding. Of 196 orthopedic patients, 84% of patients (n = 164) received DOAC (DOAC+ group), whereas 16% of patients (n = 32) did not (DOAC- group). Cumulative incidence of embolic events was observed in 1.5% of the DOAC+ group and none of the DOAC- group (p = 0.443). Cumulative incidence of bleeding events was observed in 5.1% of the DOAC+ group and none of the DOAC- group (p = 0.157). The majority of bleeding events (80%) occurred in patients with HAS-BLED scores of 3 or greater. There were no significant differences in embolic events and bleeding events in retrospective data. Balancing thrombotic risk and bleeding risk remains to be key for isolated distal DVT.