Clinical outcomes of anticoagulated vs nonanticoagulated patients with isolated distal deep venous thrombosis

Objective: The optimal clinical management of isolated distal deep venous thrombosis (IDDVT) remains controversial as the benefits of routine anticoagulant therapy are not clearly defined amid the risk of bleeding events. Our study aimed to compare clinical outcomes between patients with IDDVT treated with anticoagulation vs those managed conservatively. Methods: We performed a retrospective analysis of adults (≥18 years old) with IDDVT identified in the TriNetX Research Network from January 1, 2014, to January 1, 2024. Patients who received anticoagulation therapy within 1 week of diagnosis were compared with patients without anticoagulation therapy. Patients were 1:1 propensity score matched for baseline covariates, including demographics and various comorbidities. We calculated and compared odds ratios with 95% confidence intervals of pulmonary embolism (PE), gastrointestinal bleeding, intracranial bleeding at 6 months, and all-cause mortality at both 6 months and 1 year. Results: Propensity score matching resulted in 4085 patients in each group after matching. The incidence of PE and intracranial bleeding were not significantly different between anticoagulated or nonanticoagulated patients. The risk of gastrointestinal bleeding was significantly higher in patients receiving anticoagulation at 6 months. All-cause mortality was also significantly higher at both 6 months (4.94% vs 2.09%; P < .01) and 1 year (5.85% vs 2.82; P < .01). Conclusions: In patients with IDDVT, anticoagulation therapy did not decrease the incidence of PE. These findings suggest a more selective approach to IDDVT management rather than routine anticoagulation.