The controversy of managing calf vein thrombosis

Masuda, Elna M.; Kistner, Robert L.; Musikasinthorn, Chayanin; Liquido, Fernando; Geling, Olga; He, Qimei

doi:10.1016/j.jvs.2011.05.092

Cited by 132 publications

(85 citation statements)

References 61 publications

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“…Only a few studies, of different design (retrospective or prospective) and in different clinical settings (post-surgery, in-or outpatient, thrombosis limited to the deep muscle veins), have addressed the issue of management in patients with confirmed IDDVT (see a recent review by Masuda 46 ), often with inconsistent results. 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.…”

Section: What Is Done In Studies and In Clinical Practicementioning

confidence: 99%

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: 99%

How I treat isolated distal deep vein thrombosis (IDDVT)

Palareti

2014

Blood

107

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“…However, controversy exists regarding optimal management of DVT in the calves. 2 Given the risk of propagation, pulmonary embolism and recurrence, doing nothing is unacceptable. A systematic review of 6 randomized controlled trials (RCTs) and 25 observational studies concluded that either observation with elastic compression stockings and serial imaging surveillance, or anticoagulation therapy are acceptable management options.…”

Section: Management Of Vtementioning

confidence: 99%

“…A systematic review of 6 randomized controlled trials (RCTs) and 25 observational studies concluded that either observation with elastic compression stockings and serial imaging surveillance, or anticoagulation therapy are acceptable management options. 2 When anticoagulation is determined necessary, a 2016 guideline recommended direct anti coagulants, such as oral riva roxaban, based on six RCTs and meta-analysis. 3 Determining appropriate treatment requires consideration of provoking factors and patient preferences.…”

Section: Management Of Vtementioning

confidence: 99%

Deep vein thrombosis in a transgender woman

Chan

Drummond

Kelly

2017

CMAJ

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“…There is a risk of PE resulting from calf DVT either because of propagation or embolism from the calf itself. There are no studies of the risk of PE in stroke patients, but in other patients with calf DVT, the risk of symptomatic PE is up to 1 % and asymptomatic PE up to 6 % [ 36 ].…”

Section: Below-knee Distal or Calf Dvtmentioning

confidence: 99%

Venous Thromboembolism

Pathansali¹

2015

Management of Post-Stroke Complications

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Venous thromboembolism after acute stroke has long been a diagnostic and management problem. From the realisation in the 1970s that the incidence of deep-vein thrombosis could be as great as 75 % because of a high unrecognised subclinical element, and silent pulmonary embolism may be the cause of a high proportion of post-stroke deaths, the concern has been on how to prevent this potentially deadly complication. The use of subcutaneous low-dose anticoagulation successful in other groups of high-risk patients has been fraught with the fear of causing intracranial haemorrhage in ischaemic stroke and extending bleeding in intracranial haemorrhage. Some have felt that the benefi ts of anticoagulation outweigh the risk, especially when using low-molecular-weight heparin, others have opted for mechanical prophylaxis which until recently had scant evidence in acute stroke. Meanwhile, improvements in acute stroke care appears, in itself, to have led to a fall in the incidence of venous thromboembolism, making the case for benefi t over risk of prophylactic anticoagulation less clear. Recent large trials have also both clarifi ed and strengthened the case for mechanical thromboprophylaxis, showing clearly that graduated compression stockings were not benefi cial, but intermittent pneumatic compression did prevent deep-vein thrombosis and reduce mortality. Venous thromboembolism when it occurs should be treated as a matter of urgency with anticoagulation or an inferior vena cava fi lter if the risk of bleeding is high. Keywords Key Messages• Occurs early after stroke and presents a diagnostic and management challenge.• Risk factors include severity of the stroke, immobility, and dehydration.

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The controversy of managing calf vein thrombosis

Cited by 132 publications

References 61 publications

How I treat isolated distal deep vein thrombosis (IDDVT)

How I treat isolated distal deep vein thrombosis (IDDVT)

Deep vein thrombosis in a transgender woman

Venous Thromboembolism

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