Characteristics and Treatment Strategy of Isolated Calf Deep Venous Thrombosis after Fractures: A Review of Recent Literature

Abstract

Isolated calf deep venous thrombosis (ICDVT) includes thrombosis located at the far end of the popliteal vein, such as the anterior tibial vein, posterior tibial vein, fibular vein, and intramuscular vein of the soleus and gastrocnemius. This type of thrombosis has the highest incidence, accounting for approximately half of all deep vein thrombosis (DVT) cases; however, there is no consistent recommendation for ICDVT treatment across countries, and there is also no optimal management strategy. In recent years, increasing evidence has shown that ICDVT can develop into proximal DVT, even causing pulmonary embolism (PE). Therefore, some experts suggest anticoagulant therapy for this type of DVT, while others hold an opposing attitude. Therefore, the treatment strategy for this type of DVT has become a hot and difficult research topic. The purpose of this review is to summarize the characteristics of ICDVT and the effects of different treatment strategies by analyzing recent and important classical works in the literature in an attempt to provide recommendations for the treatment of this most common type of DVT in orthopaedic clinics.

Suboptimal Use of DOACs Post-Discharge for Geriatric Hip Fractures with Isolated Calf Deep Vein Thrombosis: Do Clinician Prescribing Preferences and Patient Compliance Alters Clinical Outcomes?

“…22 Previous studies have shown that untreated ICDVT have a tendency for proximal proliferation. 12,13 At 1 month postdischarge, the incidence of proximal propagation and localized calf propagation was 24.56% (n=14) in the DOACs poor compliance group, much higher than in the fair compliance group (7.04%, n=19) and full compliance group (2.4%, n=9), with p<0.001.This highlights the importance of patient compliance to medication regimen in preventing the progression of ICDVT.…”

“…Currently, the consistent theory holds that ICDVT is more commonly associated with transient risk factors and less often with permanent, irrevocable risk factors; furthermore, the risk of proximal propagation and recurrence is significantly lower than that of proximal DVT. 11,12 There is insufficient medical-based evidence to support the need for anticoagulation after discharge, particularly in the population of elderly patients with hip fractures. Although some suggestions or guidelines based on a weak level of evidence recommend surveillance compression ultrasound within two weeks of discharge to detect proximal propagation, few patients and clinicians choose to do so in practice.…”

“…40 Zhao et al suggest the use of individualized treatment, that is, high-risk patients should be given anticoagulation for the same duration as those with proximal DVT, and early physical activity and regular review should be encouraged in low-risk patients to monitor their progression until after at least 6 weeks. 12 A study that included 483 patients with calf vein thrombosis, including 399 patients treated with anticoagulation and 84 treated with ultrasound monitoring, showed significantly improved outcomes with anticoagulant treatment without increasing bleeding outcomes. 26 A meta-analysis of anticoagulant prolongation regimens, which included a total of 16 studies (24,930 participants), provided moderate-quality evidence for patients undergoing hip surgery to consider the use of prolonged anticoagulation to prevent venous thromboembolism; however, the benefits should be weighed against the increased risk of minor bleeding.…”

“…Although most cases of ICDVT gradually resolve with standard anticoagulation therapy, a proportion of the untreated case has a tendency to spread proximally or form the PE. [9][10][11][12][13] The high degree of uncertainty regarding the clinical relevance of and risks associated with ICDVT, however, is the reason for the variable diagnostic and therapeutic demands of orthopedic surgeons and the limited clear medical evidence (need for anticoagulants, timing, dose, and duration). 14 In actual clinical practice, there is heterogeneity in the risk-benefit analysis of anticoagulation by orthopedic surgeons and anaesthetists in elderly patients with hip fractures combined with ICDVT population, due to the need for anticoagulation, the risk of bleeding, and surgical delay, blood management.…”

Application of Acoustic Radiation Force Pulse Imaging Technology in the Evaluation of the Efficacy of Calf Intermuscular Vein Thrombosis

“…MCVT often goes unnoticed due to mild and non-acute symptoms. However, once a thrombus detaches and enters the lungs through blood circulation, it can cause pulmonary embolism [20]. Therefore, it is crucial in clinical practice to disseminate knowledge about MCVT-related detection and raise awareness among patients and healthcare professionals.…”