A meta-analysis of anticoagulation for calf deep venous thrombosis

Martino, Randall R. De; Wallaert, Jessica B.; Rossi, Ana P.; Zbehlik, Alicia J.; Suckow, Bjoern D.; Walsh, Daniel B.

doi:10.1016/j.jvs.2011.09.087

Cited by 63 publications

(47 citation statements)

References 29 publications

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“…A recent meta-analysis of available controlled studies on anticoagulation (at least 1 month of a therapeutically dosed anticoagulant drug) in patients with IDDVT included only 8 studies (most of them judged to be of poor methodological quality) and concluded that anticoagulation therapy may reduce the incidence of PE and thrombus propagation, whereas bleeding events (that were reported sparsely in the studies) seemed to favor controls. 47 Furthermore, study results are often discordant, as is the case with some recent studies on treatment of ICMVT, a condition that may be found in 20% to 40% of patients with calf vein DVT. Retrospective studies have signaled that these thromboses have a risk of extension to proximal veins.…”

Section: What Is Done In Studies and In Clinical Practicementioning

confidence: 92%

How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

107

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Thromboses limited to infrapopliteal leg deep veins (isolated distal deep vein thrombosis [IDDVT]) are frequently diagnosed in subjects with suspected pulmonary embolism or DVT and account for one-fourth to one-half of all diagnosed leg DVTs. Despite their frequency, the natural history of IDDVTs and their real risk of thromboembolic complications are still uncertain because of the scarcity of prospective, blind, nonintervention studies. Therefore it is still debated whether they warrant diagnosis and treatment. Diagnosis is based on ultrasonographic examination, which is more operator dependent and less sensitive in distal than in proximal veins. The available data seem to support the view that most IDDVTs are self-limiting and inconsequential for patients, though in some cases they can be associated with complications and warrant diagnosis and treatment. The available guidelines for treatment of IDDVTs give different indications ranging from serial imaging of the deep veins for 2 weeks to detect and treat only in case of proximal extension, to giving oral anticoagulation in all IDDVT patients for 3 months. I review this issue, focusing on possible and suggested treatments in symptomatic IDDVT patients, and describe our current therapeutic approach to these patients.

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Section: What Is Done In Studies and In Clinical Practicementioning

confidence: 92%

How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

107

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“…13 In the absence of severe symptoms or risk factors for extension the American College of Chest Physicians (ACCP) suggest serial imaging of the deep veins over initial anticoagulation in ICDVT. 14 Rapid compression ultrasound restricted to the proximal veins is simple, convenient, and widely available, but requires repeat testing in 25-50% of patients.…”

Section: Should We Diagnose Isolated Calf Vein Thrombosis and If We Dmentioning

confidence: 99%

“…ACCEPTED MANUSCRIPT 13 In patients without a provoking risk factor, the recurrence rate is low as long as patients are maintained on anticoagulants. 51 However, when the anticoagulant therapy is discontinued, the incidence of recurrent VTE is high: about 10% during the first year with a cumulative rate of 45% over 8 years.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Controversies in venous thromboembolism — 2015

2016

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“…Anticoagulants also decrease the risk for subsequent PE and the incidence of thrombi propagation [6]. However, the same Guidelines underline also the importance of early ambulation over initial bed rest (Grade 2C), as well as the preference of treatment at home instead of in-hospital treatment (Grade 1B) [5].…”

Section: Editorialmentioning

confidence: 99%

Mobilisation after Lower Limb Deep Vein Thrombosis and Post-Thrombotic Syndrome

Galyfos¹

2015

J Nov Physiother

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EditorialDeep vein thrombosis (DVT) is one of the commonest cardiovascular diseases, ranking third behind coronary artery disease and stroke [1]. Furthermore, it is one of the major causes for inhospital morbidity and mortality, leading to severe complications such as pulmonary embolism (PE), post-thrombotic syndrome (PTS) and even death [2]. Local damage to venous intima, venous stasis and hypercoagulability are major predisposing factors, and it is thought that two of these factors must be present for a DVT to develop [3].Physiotherapists frequently handle in-patients diagnosed with a DVT, and management of such patients has been controversial. For decades, conservative management of DVTs using strict immobilization was based on the theoretical assumption that early ambulation and active range of motion would cause the thrombus to dislodge proximally, migrating to the pulmonary circulation and causing a PE, possibly leading even to death [4]. However, this assumption has never been tested empirically. Moreover, such a conservative treatment approach of bed rest can lead to secondary complications and can thus be detrimental for patients [4].Concerning proper management, immediate initiation of anticoagulation, and especially low molecular weight heparins (LMWH), has been proved to be the most important first-line treatment, and therefore, is recommended for acute DVT by the latest Guidelines (Level 2B) [5]. Anticoagulants also decrease the risk for subsequent PE and the incidence of thrombi propagation [6]. However, the same Guidelines underline also the importance of early ambulation over initial bed rest (Grade 2C), as well as the preference of treatment at home instead of in-hospital treatment (Grade 1B) [5]. Additionally, many systematic reviews conclude that there is no evidence proving that ambulation by anticoagulated DVT patients in the home setting increases the risk of PE development [4,7]. Aissaoui et al. showed in their recent meta-analysis that early ambulation in patients with DVT with or without PE was not associated with increased risk for DVT progression, new PE or even death [8]. Hence, experimental data also show that even exercise does not increase the risk for new PE, regardless of thrombus status [9]. Therefore, clinicians should be confident in prescribing ambulation in this population.Fear of PE is the main rationale for bed rest, while pain and swelling are expected to resolve faster during leg elevation. However, the rate of resolution of pain and swelling is significantly faster when the patient ambulates with compression [10]. Immediate multilayer compression bandaging in the acute phase of DVT seems to be effective in reducing edema and complaints in the first week, although it has no effect on thrombus regression or valve incompetence within the following year [11]. Regarding the initiation time of ambulation after setting the diagnosis, there are controversial results in literature. Kiser et al. underline that the patient should stay immobilized for at least 48 to 72 hours whi...

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A meta-analysis of anticoagulation for calf deep venous thrombosis

Cited by 63 publications

References 29 publications

How I treat isolated distal deep vein thrombosis (IDDVT)

How I treat isolated distal deep vein thrombosis (IDDVT)

Controversies in venous thromboembolism — 2015

Mobilisation after Lower Limb Deep Vein Thrombosis and Post-Thrombotic Syndrome

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