Key result
Cancer-associated distal DVT shows comparable 90-day mortality to proximal DVT but less fatal PE.
Why the study?
Patients with isolated distal DVT have lower adverse outcome rates than those with proximal DVT, but whether this applies to patients with cancer remains uncertain.
Does cancer-associated distal DVT have different risks of adverse outcomes compared to cancer-associated proximal DVT or non-cancer-associated distal DVT?
Observational (n=12,056)
Yes
Does cancer-associated distal DVT have different risks of adverse outcomes compared to cancer-associated proximal DVT or non-cancer-associated distal DVT?
Odds Ratio: 1.11 (95% CI 0.91–1.36)
Cancer-associated distal DVT has comparable risks of death, VTE recurrence, and major bleeding as cancer-associated proximal DVT, suggesting it is a serious condition requiring similar clinical attention.
May support similar vigilance for cancer-associated distal as proximal DVT; leaves open optimal management pending trials.
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.
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Galanaud et al. (2023) conducted an observational in Cancer-associated isolated distal deep vein thrombosis (n=12,056). Cancer-associated proximal DVT vs. Cancer-associated distal DVT was evaluated on Death at 90 days (aOR 1.11, 95% CI 0.91-1.36). Cancer-associated distal DVT had comparable 90-day mortality compared to cancer-associated proximal DVT (aOR 1.11; 95% CI 0.91-1.36), but a lower risk of fatal pulmonary embolism.
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