The efficacy and safety of anticoagulant treatment is not established for patients with acute symptomatic isolated distal deep vein thrombosis (IDDVT). The latest Antithrombotic Therapy for VTE Disease Guideline suggested using the same anticoagulation as for patients with acute proximal DVT in patients with acute IDDVT. However, a single-center retrospective cohort study found therapeutic anticoagulation was associated with an increase risk of bleeding. Thus, this study aimed to assess the short-term risk of recurrent venous thrombotic events and bleeding events in patients with a first acute symptomatic IDDVT of the leg treated with prophylactic or therapeutic anticoagulant therapy with rivaroxaban.

Inclusion Criteria:

• Patients aged 18-90
• Outpatients with a first, acute (within 2 weeks), symptomatic, objectively confirmed isolated distal DVT
• Compliance to the scheduled follow up plan
• Ability and willing to participate and sign the informed consent.

Exclusion Criteria:

• Any absolute contraindication to anticoagulant treatment
• Pregnancy or breast-feeding
• Systolic pressure > 180 mmHg or diastolic pressure > 100 mmHg
• Platelet count < 100 × 10⁹ /L
• Serum creatinine > 180 mmol/L or creatinine clearance ≤30 ml/min
• Liver disease associated with coagulopathy and high risk of bleeding
• Clinically suspected or confirmed pulmonary embolism
• Ipsilateral or contralateral proximal DVT
• Any indication for long-term anticoagulation
• Enrolled in another clinical trial simultaneously
• Life expectancy < 6 months