Anticoagulation in Patients with Isolated Distal Deep Vein Thrombosis: Bringing the Puzzle Together

Whether and how to prescribe anticoagulant treatment in patients with acute isolated distal deep vein thrombosis (IDDVT) is a long-lasting, recurring, and debated issue.[ 1 ] IDDVT affects the infrapopliteal veins, comprising the axial (peroneal, anterior, and posterior tibial), and muscular (soleal and gastrocnemius muscle) veins, which proximally form the trifurcation area before merging into the popliteal vein. While the trifurcation anatomically belongs to the distal venous district, thrombosis involving this area is often considered as proximal deep vein thrombosis (DVT).[ 1 ] IDDVT is a frequent manifestation of venous thromboembolism (VTE) disease, accounting for up to 50% of all DVTs.[ 1 ] Traditionally perceived as far more benign than proximal DVT, IDDVT may also result in clot extension, pulmonary emboli, and recurrent VTE if left untreated.[ 1 ] Similar to proximal DVT, recurrence risk tends to be higher in patients with cancer-associated or unprovoked IDDVT than in those with transient risk factors.[ 2 ] [ 3 ] [ 4 ] In high-risk subgroups, long-term recurrence rates may reach those observed in patients with proximal DVT.[ 2 ] [ 3 ] [ 4 ] Despite this, the management of IDDVT remains uncertain and widely heterogenous across centers worldwide. IDDVT has long been understudied until recent times. This Editorial Focus outlines latest relevant research findings with particular attention to two recent randomized controlled studies, namely the RIDTS[ 5 ] and ONCO DVT[ 6 ] trials, and discusses how these may advance personalized management of patients with IDDVT. Authors' Contribution All authors contributed to review and editing of the manuscript. Publication History Received: 06 January 2024 Accepted: 18 January 2024 Accepted Manuscript online: 19 January 2024 Article published online: 07 February 2024 © 2024. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany