Key result
Compared with isolated distal DVT, proximal DVT was associated with higher rates of recurrent VTE (OR 1.62; 95% CI 1.35-1.93; P<.001), pulmonary embolism, major bleeding, and mortality.
Why the study?
Due to a lack of prospective studies and conflicting perspectives on its potential to lead to pulmonary embolism, the management of isolated distal DVT remains contentious.
Do clinical outcomes such as recurrent VTE, pulmonary embolism, and mortality differ between patients with proximal deep vein thrombosis versus isolated distal deep vein thrombosis?
Meta-Analysis
Do clinical outcomes such as recurrent VTE, pulmonary embolism, and mortality differ between patients with proximal deep vein thrombosis versus isolated distal deep vein thrombosis?
This meta-analysis demonstrates that proximal DVT carries a significantly higher risk of recurrent VTE, pulmonary embolism, major bleeding, and all-cause mortality compared to isolated distal DVT.
OBJECTIVE: Deep vein thrombosis (DVT) ranks among the top five most prevalent vascular diseases globally and encompasses proximal deep vein thrombosis (PDVT) and isolated distal deep vein thrombosis (IDDVT). IDDVT affects approximately 50% to 65% of patients with DVT. However, due to a lack of prospective studies and conflicting perspectives on its potential to lead to pulmonary embolism (PE), the management of IDDVT remains contentious. Therefore, this meta-analysis was conducted to compare the clinical outcomes of PDVT and IDDVT. METHOD: We searched studies including proximal and isolated distal thrombotic outcomes in the electronic databases PubMed, EMBASE, Cochrane, and Web of Science. The literature was then screened based on title, abstract, and full text to exclude those that did not meet the criteria. A total of 21 cohort and randomized controlled studies were included. RESULTS: Compared with IDDVT, PDVT was associated with higher rates in recurrent vein thromboembolism (VTE) (odds ratio [OR], 1.62; 95% confidence interval [CI], 1.35-1.93; P < .001), PE (OR, 1.52; 95% CI, 1.16-1.99; P = .002), major bleeding (OR, 1.95; 95% CI, 1.23-3.09; P = .005), and all-cause mortality (OR, 2.02; 95% CI, 1.19-3.44; P = .009). However, no significant differences were found in the rates of any bleeding (OR, 1.57; 95% CI, 0.96-2.58; P = .070) and nonmajor bleeding (OR, 1.03; 95% CI, 0.69-1.54; P = .88). CONCLUSIONS: Compared with patients with PDVT, patients with IDDVT may have lower rates of recurrent VTE, PE, major bleeding events, and all-cause mortality, demonstrating safer clinical outcomes.
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Zhang et al. (2025) conducted a meta-analysis in Deep vein thrombosis (DVT). Proximal deep vein thrombosis (PDVT) vs. Isolated distal deep vein thrombosis (IDDVT) was evaluated on Recurrent vein thromboembolism (VTE) (OR 1.62, 95% CI 1.35-1.93, p=<.001). Compared with isolated distal DVT, proximal DVT was associated with higher rates of recurrent VTE (OR 1.62; 95% CI 1.35-1.93; P<.001), pulmonary embolism, major bleeding, and mortality.
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