Key result
Enoxaparin 4000 units daily reduced the risk of the composite of popliteal vein extension and bleeding compared with intermediate doses (4.9% vs 24.4%; OR 6.31; 95% CI 1.56-42.65; P=0.02).
Why the study?
Early outcomes of inpatients with isolated distal deep vein thrombosis and coexisting bleeding were not well defined.
Does enoxaparin 4000 units daily reduce the composite of proximal extension and bleeding compared to intermediate doses in inpatients with isolated distal deep vein thrombosis and coexisting bleeding?
Observational (n=95)
Does enoxaparin 4000 units daily reduce the composite of proximal extension and bleeding compared to intermediate doses in inpatients with isolated distal deep vein thrombosis and coexisting bleeding?
In patients with isolated distal DVT and contraindications to full anticoagulation, enoxaparin 4000 units daily reduced the composite of proximal extension and bleeding compared to intermediate doses.
BACKGROUND: This prospective observational study was aimed at assessing early outcomes of inpatients with isolated distal deep vein thrombosis (IDDVT) and coexisting bleeding. METHODS: Patients received enoxaparin 4000 units daily or intermediate doses, and ultrasound surveillance (US). Primary outcomes were extension to the popliteal vein (PDVT) or symptomatic pulmonary embolism (PE), bleeding complications during the treatment and the composite of PDVT and bleeding complications. Secondary outcomes were recurrent IDDVTs and death. RESULTS: 90/95 patients completed the study period (30 days). PDVT occurred in 2/41 (4.9%) and in 3/45 (6.7%) subjects receiving enoxaparin 4000 units and intermediate doses respectively (OR 1.39; 95% CI: 0.22-11; P=0.72). PE occurred in only one of the 4 untreated subjects (25% vs. 0 patients taking enoxaparin 4000 units or intermediate doses; P=1.0). Recurrent IDDVTs occurred in 29 subjects (32.2%), more frequently during enoxaparin 4000 (19/29, 65.5%). Four patients died (4.4%). Bleeding complications occurred in 8 subjects (8.9%), all treated with intermediate doses (0 vs. 17.8%; P=1.0). Enoxaparin 4000 units significantly reduced the risk of the composite outcome compared with higher doses (4.9% vs. 24.4%; OR 6.31; 95% CI: 1.56-42.65; P=0.02). Major trauma significantly increased the risk of PDVT (OR 20.92; 95% CI: 2.82-427.51, P=0.01; logistic regression P=0.01). Patients with major trauma are also at increased bleeding risk (OR 5; 95% CI: 1.06-23.76, P=0.04; logistic regression P=0.03). CONCLUSIONS: Enoxaparin 4000 units daily, supported by US, may be an option for selected patients.
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Elmi et al. (2023) conducted an observational in Isolated distal deep vein thrombosis (IDDVT) and coexisting bleeding (n=95). Enoxaparin vs. Intermediate doses was evaluated on Composite of extension to the popliteal vein (PDVT) and bleeding complications (OR 6.31, 95% CI 1.56-42.65, p=0.02). Enoxaparin 4000 units daily reduced the risk of the composite of popliteal vein extension and bleeding compared with intermediate doses (4.9% vs 24.4%; OR 6.31; 95% CI 1.56-42.65; P=0.02).
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