Clinical Presentation and Outcomes of Patients With Cancer-Associated Isolated Distal Deep Vein Thrombosis
Authors: Galanaud Jean-Philippe , Trujillo-Santos Javier , Bikdeli Behnood , Bertoletti Laurent , Di Micco Pierpaolo , Poénou Géraldine , Falgá Conxita , Zdraveska Marija , Lima Jorge , Rivera-Civico Francisco , Muixi Josefa Fernández , Monreal Manuel ,   on behalf of the RIETE Investigators, Adarraga María Dolores , Alberich-Conesa Ana , Agudo Paloma , Aibar Jesús , Alfonso Joaquín , Amado Cristina , Amorós Soraia , Angelina-García María , Arcelus Juan Ignacio , Ballaz Aitor , Barba Raquel , Barbagelata Cristina , Barrón Manuel , Barrón-Andrés Belén , Bascuñana José , Beddar-Chaib Fahd , Blanco-Molina Ángeles , Botella Ernesto , Chasco Leyre , Cerdà Pau , Criado Juan , Toro Jorge del , De Ancos Cristina , Demelo-Rodríguez Pablo , De Juana-Izquierdo Cristina , Díaz-Brasero Ana María , Díaz-Pedroche María del Carmen , Díaz-Peromingo José Antonio , Dubois-Silva Álvaro , Escribano José Carlos , Espósito Francis , Falgá Conxita , Farfán-Sedano Ana Isabel , Fernández-Aracil Cloefe , Fernández-Capitán Carmen , Fernández-Jiménez Begoña , Fernández-Muixi Josefa , Fernández-Reyes José Luis , Font Carme , Francisco Iria , Gabara Cristina , García de Herreros Marta , García-Bragado Ferrán , García-Ortega Alberto , Gavín-Sebastián Olga , Gil-De Gómez María , Gil-Díaz Aída , Gómez-Cuervo Covadonga , González-Martínez José , Grau Enric , Guirado Leticia , Gutiérrez Javier , Hernández-Blasco Luis , Jaras María Jesús , Jiménez David , Jou Inés , Joya María Dolores , Lago-Rodríguez Marta Olimpia , Lainez-Justo Sara , Latorre-Díez Ana , Lecumberri Ramón , León-Ramírez José Manuel , Lima Jorge , Lobo José Luis , López-De la Fuente Meritxell , López-Jiménez Luciano , López-Miguel Patricia , López-Núñez Juan José , López-Reyes Raquel , López-Ruiz Antonio , López-Sáez Juan Bosco , Lorente Manuel Alejandro , Lorenzo Alicia , Lumbierres Marina , Madridano Olga , Maestre Ana , Mas-Maresma Laia , Marcos María , Martín-Guerra Javier Miguel , Martín-Martos Francisco , Martínez-Redondo Iván , Mellado Meritxell , Mena Elisabeth , Mercado María Isabel , Moisés Jorge , Monreal Manuel , Muñoz-Blanco Arturo , Muñoz-Gamito Gema , Navas María Sierra , Nieto José Antonio , Noguera-Gras Elisabeth , Núñez-Fernández Manuel Jesús , Olid-Velilla Mónica , Ordieres-Ortega Lucia , Ortiz María , Osorio Jeisson , Otálora Sonia , Pacheco-Gómez Nazaret , Paredes-Ruiz Diana , Parra Pedro , Pedrajas José María , Pérez-Ductor Cristina , Peris María Luisa , Pesce María Lourdes , Porras José Antonio , Poyo-Molina Javier , Puchades Ramón , Riera-Mestre Antoni , Rivera-Civico Francisco , Rivera-Gallego Alberto , Roca Mireia , Rosa Vladimir , Rodríguez-Cobo Ana , Rodríguez-Matute Consolación , Rubio Carmen María , Ruiz-Artacho Pedro , Ruiz-Giménez Nuria , Ruiz-Ruiz Justo , Salgueiro Giorgina , Sancho Teresa , Sendín Vanesa , Sigüenza Patricia , Soler Silvia , Suárez-Rodríguez Beatriz , Suriñach José María , Tirado Raimundo , Tolosa Carles , Torres María Isabel , Trujillo-Santos Javier , Uresandi Fernando , Valle Reina , Varona José Felipe , Vidal Gema , Villares Paula , Ay Cihan , Nopp Stephan , Pabinger Ingrid , Martens Caroline , Vanassche Thomas , Verhamme Peter , Bok Yoo Hugo Hyung , Arguello Jesús David , Montenegro Ana Cristina , Roa Jairo , Hirmerova Jana , Malý Radovan , Accassat Sandrine , Bertoletti Laurent , Bura-Riviere Alessandra , Catella Judith , Chopard Romain , Couturaud Francis , Espitia Oliver , Grange Claire , Leclercq Barbara , Le Mao Raphael , Mahé Isabelle , Moustafa Farés , Plaisance Ludovic , Poenou Géraldine , Sarlon-Bartoli Gabrielle , Suchon Pierre , Versini Edouard , Schellong Sebastian , Brenner Benjamin , Dally Najib , Tzoran Inna , Kaviani Raheleh , Moosavi Jamal , Sadeghipour Parham , Basaglia Manuela , Bilora Franca , Bortoluzzi Cristiano , Brandolin Barbara , Ciammaichella Mauricio , Colaizzo Donatella , Dentali F Francesco , Di Micco Pierpaolo , Giorgi-Pierfranceschi Matteo , Grandone Elvira , Imbalzano Egidio , Merla Simona , Pesavento Raffaele , Prandoni Paolo , Scarinzi Paolo , Siniscalchi Carmine , Taflaj Beldisa , Tufano Antonella , Visonà Adriana , Hong Ngoc Vo , Zalunardo Beniamino , Kigitovica Dana , Paluga Rolands , Skride Andris , Fonseca Samuel , Manuel Micaela , Meireles Jose , Pinto Sara , Bosevski Marijan , Lazarova Emilija , Zdraveska Marija , Bounameaux Henri , Mazzolai Lucia , Caprini Joseph A. , Weinberg Ido , Bui Hanh My 
Published: July 2023

PURPOSE

Patients with isolated distal deep vein thrombosis (DVT) have lower rates of adverse outcomes (death, venous thromboembolism [VTE] recurrence or major bleeding) than those with proximal DVT. It is uncertain if such findings are also observed in patients with cancer.

METHODS

Using data from the international Registro Informatizado de la Enfermedad TromboEmbolica venosa registry, we compared the risks of adverse outcomes at 90 days (adjusted odds ratio [aOR]; 95% CI) and 1 year (adjusted hazard ratio [aHR; 95% CI]) in 886 patients with cancer-associated distal DVT versus 5,196 patients with cancer-associated proximal DVT and 5,974 patients with non–cancer-associated distal DVT.

RESULTS

More than 90% of patients in each group were treated with anticoagulants for at least 90 days. At 90 days, the adjusted risks of death, VTE recurrence, or major bleeding were lower in patients with non–cancer-associated distal DVT than in patients with cancer-associated distal DVT (reference): aOR = 0.16 (0.11-0.22), aOR = 0.34 (0.22-0.54), and aOR = 0.47 (0.27-0.80), respectively. The results were similar at 1-year follow-up: aHR = 0.12 (0.09-0.15), aHR = 0.39 (0.28-0.55), and aHR = 0.51 (0.32-0.82), respectively. Risks of death, VTE recurrence, and major bleeding were not statistically different between patients with cancer-associated proximal versus distal DVT, both at 90 days: aOR = 1.11 (0.91-1.36), aOR = 1.10 (0.76-1.62), and aOR = 1.18 (0.76-1.83), respectively, and 1 year: aHR = 1.01 (0.89-1.15), aHR = 1.02 (0.76-1.35), and aHR = 1.10 (0.76-1.61), respectively. However, more patients with cancer-associated proximal DVT, compared with cancer-associated distal DVT, developed fatal pulmonary embolism (PE) during follow-up: The risk difference was 0.40% (95% CI, 0.23 to 0.58).

CONCLUSION

Cancer-associated distal DVT has serious and relatively comparable outcomes compared with cancer-associated proximal DVT. The lower risk of fatal PE from cancer-associated distal DVT needs further investigation.