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Abstract Background Distal deep vein thrombosis (infrapopliteal DVT without proximal DVT or pulmonary embolism [PE]) generally shares the same triggering risks factors as proximal DVT. In women of childbearing age, a frequent triggering risk factor is the use of combined oral contraceptive (COC) pills. However, data on the epidemiology and long‐term outcomes of COC‐associated distal DVT are lacking. Objectives To assess the epidemiology and long‐term outcomes of COC‐associated distal DVT. Methods Using data from the OPTIMEV (Optimisation de l’Interrogatoire dans l’évaluation du risque thrombo‐Embolique Veineux [Optimization of Interrogation in the Assessment of Thromboembolic Venous Risk]) multicenter cohort study of patients with objectively confirmed venous thromboembolism (VTE) enrolled between 2004 and 2006, we assessed in nonpregnant or postpartum women aged ≤ 50 years without cancer or history of VTE (i) proportion of COC‐associated distal DVTs among women with distal DVTs and among women with COC‐associated VTEs (distal DVT, proximal DVT, or PE) and (ii) 3‐year incidence of death, bleeding, and VTE recurrence. Results COC‐associated distal DVTs (n = 54) represented 43.9% of all distal DVTs and 51.9% of COC‐associated VTEs. All but one woman with a COC‐associated distal DVT received therapeutic anticoagulation for a median of 3 months. At 3‐year follow‐up, all women with COC‐associated distal DVTs were alive, and none had bled during anticoagulant treatment or had experienced a DVT or PE recurrence after stopping anticoagulants. Similar results were found in patients with COC‐associated proximal DVT and PE: The VTE recurrence rate was 1.7% per patient‐year (PY) and 0% PY, respectively, and there were no deaths or major bleeds in either group. Conclusions Distal DVT was the most frequent clinical presentation of COC‐associated VTE and had similarly favorable long‐term outcomes as other COC‐associated VTE.

Abstract Introduction Elastic compression stockings (ECSs) are used to treat symptoms of venous insufficiency. However, lack of patient compliance can limit their effectiveness. In a secondary analysis of the SOX Trial, a randomized trial of active vs. placebo ECSs worn for 2 years to prevent postthrombotic syndrome after deep vein thrombosis, we aimed to describe patient‐reported reasons for nondaily use of ECS and to identify predictors of noncompliance during follow‐up. Methods At each follow‐up visit of the SOX Trial, patients were asked how many days per week they wore study stockings, and if not worn daily, to specify the reason(s). Reasons for nondaily use of ECSs were tabulated. Multiple logistic regression modeling was used to identify predictors of stocking noncompliance during follow‐up (defined as use

Abstract Introduction Postthrombotic syndrome (PTS) is a form of secondary chronic venous insufficiency (CVI) that occurs after deep vein thrombosis (DVT). Effective treatments for PTS are lacking. Micronized purified flavonoid fraction (MPFF) is a venoactive drug used in the treatment of CVI. Objective To determine whether MPFF is a good candidate to explore as a therapeutic agent for PTS. Methods We performed a narrative review in which we identified 14 systematic reviews, 33 randomized controlled trials, and 19 observational studies that discussed the use of MPFF in CVI, as well as studies that reported on the mechanistic action of MPFF in relation to the pathophysiology of PTS. Results MPFF targets a number of pathophysiologic components of PTS. Based on animal models and human studies investigating objective vascular and lymphatic measures, MPFF promotes venous recanalization after DVT, decreases venous remodeling and reflux, inhibits inflammatory processes, improves venous tone and stasis, improves lymphatic circulation, improves capillary hyperpermeability, and decreases tissue hypoxia. Furthermore, MPFF shows promise in improving clinical manifestations, quality of life, and objective venous parameters of CVI. Studies suggest good patient acceptability and tolerability with the use of MPFF in CVI. Conclusion MPFF is a good candidate to explore as a potential therapy for PTS. Confirmatory high‐quality studies are still needed to reinforce the evidence supporting the use of MPFF in CVI. Double‐blind randomized controlled trials with clinical endpoints are needed to assess the clinical efficacy of MPFF in the treatment of PTS.