What question did this study set out to answer?

To assess the incidence and predictors of recurrent venous thromboembolism after treatment for isolated distal deep vein thrombosis.

July 4, 2026Haematologica0 citationsOpen Access

Incidence and predictors of recurrent venous thromboembolism after isolated distal deep vein thrombosis: a post-hoc analysis of the RIDTS trial

NPNicola PotereUniversity of Ottawa LBLorenza BertùUniversity of Insubria EBEugenio BucheriniAzienda Unità Sanitaria Locale Della Romagna

Key Points

To assess the incidence and predictors of recurrent venous thromboembolism after treatment for isolated distal deep vein thrombosis.
Post-hoc analysis of the RIDTS trial comparing 6 vs. 12 weeks of rivaroxaban.
398 participants with isolated distal deep vein thrombosis without cancer were followed after anticoagulation cessation.
Multivariable analysis was performed to identify predictors of recurrence.
15.3% of participants experienced recurrent venous thromboembolism, with higher rates in those treated for 6 weeks (24.4%) vs. 12 weeks (7.5%).
Key predictors of recurrence included shorter anticoagulation duration (HR 1.8), diabetes (HR 2.5), and unprovoked distal deep vein thrombosis (HR 3.2).
Recurrent venous thromboembolism occurred in both symptomatic (63.9%) and asymptomatic (36.1%) cases.

Abstract

Contemporary data on recurrent venous thromboembolism (VTE) after anticoagulation for isolated distal deep vein thrombosis (IDDVT) are limited. This post-hoc analysis of the Rivaroxaban for the treatment of symptomatic Isolated Distal deep vein ThrombosiS (RIDTS) trial-a randomized, double-blind trial comparing 6 vs. 12 weeks of rivaroxaban in patients with IDDVT without cancer- evaluated the short- and long-term incidence and predictors of post-treatment recurrent VTE. Sixty-one of 398 (15.3%) participants experienced recurrent VTE (median time from anticoagulation cessation, 6.2 months): 47 (77%) events were recurrent IDDVT, and 14 (23%) proximal DVT (nine, 14.8%) or symptomatic pulmonary embolism (five, 8.2%); 39 (63.9%) recurrences were symptomatic and 22 (36.1%) asymptomatic. During follow-up, six (1.5%) participants died (no deaths attributable to pulmonary embolism). The 6- and 24-month incidence rates per 100/person-years of any recurrence were: 15.8 (95% confidence interval CI, 11.0-22.7) and 10.0 (95%CI, 7.8-12.9), respectively. The corresponding values were: 24.1 (95%CI, 16.1-36.4) and 15.7 (95%CI, 11.8-20.9) after unprovoked IDDVT; and 6.8 (95%CI, 3.0-15.1) and 4.5 (95%CI, 2.7-7.7) after provoked IDDVT. Recurrence rates were higher in patients who received 6 vs. 12 weeks of rivaroxaban, especially early after discontinuation (24.4 95%CI, 16.1-37.0 and 7.5 95%CI, 3.6-15.7 during the first 6 months, respectively). In multivariable analysis, shorter duration of anticoagulation (hazard ratio HR, 1.8; 95%CI, 1.1-3.0), diabetes (HR, 2.5; 95%CI, 1.1-5.3) and unprovoked IDDVT (HR, 3.2; 95%CI, 1.7-5.7) were associated with increased posttreatment recurrence risk. In patients with IDDVT and without cancer completing 6-to-12 weeks of anticoagulation, recurrent VTE was not infrequent in selected subgroups; these data may inform improved risk stratification and individualized management.

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