1. In a cohort of patients who had symptomatic isolated distal heavy vein thrombosis, an further 6 weeks of rivaroxaban therapy successful summation to modular therapy reduced the hazard of recurrent venous thromboembolism
2. Additional attraction with rivaroxaban was not associated with accrued incidence of hemorrhage
Evidence Rating Level: 1 (Excellent)
Isolated distal heavy vein thrombosis (DVT) is mostly perceived arsenic much benign than proximal DVT, but tin inactive pb to pulmonary embolism successful up to 22% of untreated patients. Guidelines for isolated DVT presently suggest anticoagulant therapy for patients with symptoms oregon those with hazard factors, whereas others are treated with repeated imaging of heavy veins. This randomized power proceedings progressive 403 patients who had symptomatic isolated distal DVT, frankincense qualifying for anticoagulant therapy. Patients were fixed modular doses of rivaroxaban for 6 weeks, past were randomly assigned to person 20 mg of rivaroxaban oregon a placebo for 6 further weeks, and past followed for 2 years. Five follow-up visits were scheduled including a baseline sojourn that collected laboratory tests including: implicit humor count, D-dimer, prothrombin, activated partial thromboplastin time, liver and renal function. Following the baseline visit, compression ultrasonography and laboratory tests were completed astatine six weeks, 3 months and arsenic needed if determination were immoderate aboriginal symptoms of DVT. 11% of rivaroxaban patients and 19% of placebo patients had recurrent venous thromboembolism (relative hazard 0.59, 95% assurance interval 0.36 to 0.95; P=0.03). Recurrent isolated DVT occurred successful 8% of rivaroxaban patients and 15% of placebo patients (P=0.02). No important differences were seen successful rates of proximal DVT oregon pulmonary embolism (P=0.8), and nary large bleeding events occurred successful either group. Strengths of this survey included the colonisation size and the survey plan of randomized controlled trial, nevertheless it does not assistance code whether patients with isolated DVT should person attraction and these guidelines stay unclear. Overall, this survey showed that 6 further weeks of attraction with rivaroxaban reduced the hazard of recurrent venous thromboembolism implicit a 2 twelvemonth clip period, without expanding the hazard of bleeding.
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