For Isolated Distal Deep Venous Thrombosis, 3 Months of Anticoagulation Is Superior to 6 Weeks

Guidelines suggest that patients with isolated distal deep venous thrombosis (DVT) require treatment only if they have severe symptoms or risk factors for progression; otherwise, serial imaging for 2 weeks is recommended (e.g., Chest 2016; 149:315). Observational studies, however, show that most patients with isolated distal DVTs do receive treatment, although for shorter durations than patients with proximal DVTs, and that recurrence rates are lower with treatment than with serial imaging. The optimal duration of treatment for patients who receive anticoagulation remains unclear.

Investigators identified 400 patients with symptomatic isolated distal DVT who had completed 6 weeks of rivaroxaban treatment without complications and randomized …