Should Patients with Distal DVT Receive Pharmacologic Therapy?

For patients with acute isolated deep venous thrombosis (DVT) of a distal lower extremity, guidelines currently recommend anticoagulation for higher-risk patients (i.e., those with active cancer, extensive clot burden, unprovoked DVT, or prior venous thromboembolism) and serial imaging of the deep veins for 2 weeks for lower-risk patients (NEJM JW Emerg Med Feb 2016 and Chest 2016; 149:315). In a meta-analysis of eight randomized, controlled trials (most unblinded;), researchers compared 1239 patients with distal DVT who received anticoagulation with those who received serial imaging only. They also evaluated various durations of anticoagulation therapy. Five of the eight studies (with 1046 patients) excluded high-risk patients (i.e., those…